Loading...
HomeMy WebLinkAboutCC Resolution 7972 (95 Medway Rd)RESOLUTION NO. 7972 RESOLUTION AUTHORIZING THE MAKI14G OF AN ACQUISITION LOAN TO THE MARIN HOUSING DEVELOPMENT CORPORATION IN CONNECTION WITH PROPERTY LOCATED AT 95 MEDWAY ROAD IN SAN RAFAEL, CA A.P.#14-193-03 WHEREAS, the San Rafael City Council has established a housing fund; and WHEREAS, the Marin Housing Development Corporation has requested that $50,000 be made available from this fund to help fund the acquisition of rental property in East San Rafael; and WHEREAS, Implementing Program H -r, entitled Acquisi- tion of Rental Housing in the City's Housing Goals and Policies, of the San Rafael General Plan strongly encourages the acquisition by non-profit organizations including the use of the City's Housing Fund to implement this program. NOW, THEREFORE, IT IS HEREBY ORDERED AND RESOLVED that the City Council authorizes the City Manager to execute all necessary documents to make a loan in the amount of $50,000 to the Marin Housing Development Corp- poration for the purchase of 28 apartment units at 95 Medway Road in San Rafael, CA. I, JEANNE M. LEONCINI, Clerk of the City of San Rafael, hereby certify that the foregoing resolution was duly and regularly introduced and adopted at a Regular meeting of the Council of said City on Monday , the 15th vote, to wit: day of May , 1989, by the following AYES: COUNCILMEMBERS:Boro, Breiner, Frugoli, Thayer & Mayor Mulryan NOES: COUNCILMEMBERS:None ABSENT: COUNCILMEMBERS:None J6KNM M. LEONCI I, City Clerk CITY LOAN AGREEMENT THIS AGREEMENT is entered into as of this 14th day of July, 1989, by and between the City of San Rafael, California, a public entity ("City") and Marin Housing Development Corporation, a California nonprofit corporation ("Borrower"). This Agreement is entered into on the basis of the following facts, intentions and understanding of the parties: A. Borrower is organized for the purpose of providing low and moderate income housing units. B. Borrower desires to acquire an existing 28 -unit rental housing project for low and moderate income households known as Sundance Apartments (the "Project") located at 95 Medway, San Rafael, Marin County, California (the "Property"), more particularly described in Exhibit "A" attached hereto and incorporated herein. C. Borrower will operate the Project as a rental housing development for very low and low income households which will benefit the City and its residents. D. To provide additional financing for the acquisition of the Property, Borrower has applied for, and City has approved, a $50,000 loan to Borrower from City. E. The purpose of this City Loan Agreement is to set forth the terms and conditions upon which City will loan the funds to Borrower in order for Borrower to acquire the Property. IN CONSIDERATION FOR THEIR MUTUAL UNDERTAKINGS, THE PARTIES HERETO AGREE AS FOLLOWS: SECTION ONE: CITY LOAN; LOAN CLOSING; CLOSING DOCUMENTS 1.01 City Loan. Subject Lu the terms and conditions of this Agreement, City agrees to lend Borrower Fifty Thousand and No/100th Dollars ($50,000.00). The $50,000.00 loan (the "City Loan") to Borrower shall be evidenced by a Promissory Note and shall have the following terms: (a) Payments of principal and Contingent Interest shall be equal to twenty-five percent (25%) of the Net Cash Flow (defined below) from that 28 -unit project known as Sundance Apartments located at 95 Medway, San Rafael, California (the "Project"). The Net Cash Flow from the Project shall be computed by Borrower on a semi-annual basis, which shall end on each June 30 and December 31. No payments of principal or Contingent Interest shall be due or payable before December 31, 1991. Within thirty (30) days after the end of the semi-annual period ending on December 31, 1991, Borrower sh?" ^ , *^ 12 i Clp_kfi))� - 17Z CODY 34d:Loanagmt.CSR 1 City twenty-five percent (25%) of the Net Cash Flow from the Project, if any, for the preceding semi-annual period. Thereafter, within thirty (30) days of each and every succeeding semi-annual period, Borrower shall pay to City twenty-five percent (25%) of the Net Cash Flow from the Project, if any, for the preceding semi-annual period, until the semi-annual period ending on December 31, 2005. The maturity date of this Note shall be thirty (30) days after December 31, 2005. If, on the maturity date, at least $50,000.00 of principal and Contingent Interest shall not have been paid to City, the unpaid balance of the $50,000.00 shall be due and payable. (b) As used herein, Net Cash Flow shall mean all gross income generated by the Project less all operating expenses and debt service requirements for Savings Associations Mortgage Company, Inc.'s ("SAMCO") loan in the amount of $1,450,000.00 secured by the first deed of trust on the Project and the seller's loan in the amount of $350,000.00 secured by the second deed of trust on the Project. Operating expenses shall include reasonable expenses actually incurred by Borrower in connection with the ownership, operation, leasing and occupancy of the Project, determined on the basis of generally accepted accounting principles, including, but not limited to, real estate taxes and assessments, personal property taxes, property, flood and liability insurance, costs of utilities, maintenance, repair and replacement costs, management agent expenses and fees, resident manager salary and expenses, accounting and audit fees and costs, attorneys' fees and other administrative and general expenses and disbursements. Net Cash Flow from the Project shall be divided and disbursed as follows: Twenty-five percent (25%) to Borrower, 25% to City to debt service the Borrower's obligations under this Note, 25% to the County of Marin debt service Borrower's obligations under the County's note secured by the fourth deed of trust on the Project, and 25% to the Marin County Housing Authority to debt service Borrower's obligations under the Housing Authority's note secured by the fifth deed of trust on the project. (c) With each payment of principal and Contingent Interest and in any event within thirty (30) days after the end of each semi-annual period, Borrower shall furnish to City a written report certified by one of its Directors or Officers which report shall indicate the gross income, operating expenses, debt service requirements, Net Cash Flow, and principal and Contingent Interest payments for such semi-annual period. (d) Borrower acknowledges that Borrower and City have conferred specifically concerning the contingent and uncertain nature of the Contingent Interest and that Borrower and Cizy understand and agree that the Contingent Interest payable under this Note is speculative in nature, and both the payment and amount, if any, of the Contingent Interest are dependent on a number of contingencies which are not within the City's control. City has not been guaranteed by Borrower (or by any other party) of the receipt of any part of the Contingent Interest, and City has not required that any fixed amount of interest or Contingent Interest be paid to City in connection with this Note. (e) Notwithstanding anything to the contrary the Deed of Trust or in any other instrument evidencing obligations of Borrower under the Note, the holder of the Note in the Note, in or securing the expressly agrees 34d:Loanagmt.CSR 2 (6/22/89) that there shall be no personal liability of Borrower under the Note, under the Deed of Trust and under any other instrument given to evidence or secure the obligations of Borrower under the Note. The liability of Borrower shall be strictly and absolutely limited to the property conveyed by the Deed of Trust and the rents, profits, issues, products and proceeds thereof. In the event a default shall occur under the Note or with respect to the indebtedness evidenced by the Note, the holder of the Note shall not seek any judgment for a deficiency against Borrower or the legal representatives, successors or assigns of Borrower. 1.02 Securitv for Citv Loan. The City Loan shall be secured by a third Deed of Trust (the "City Deed of Trust") on the Property. . The City Deed of Trust shall be subject to a first deed of trust securing a loan from SAMCO in the principal amount not to exceed $1,450,000.00, and a second deed of trust securing the seller's loan in the amount of $350,000.00. The City Deed of Trust shall be senior to a fourth deed of trust securing a loan from the County of Marin in the amount of $75,000.00, and a fifth deed of trust securing a loan from the Housing Authority of City of Marin in the amount of $100,000.00. 1.03 Closinq Documents. The loan closing shall be held at a time and place designated by the lenders. At or before the closing, Borrower shall execute and deliver to City the following items in a form satisfactory to City. a. This City Loan Agreement; b. A $50,000.00 Promissory Note (the "Note") substantially in the form of Exhibit "B" attached hereto; c. The City Deed of Trust securing the City Loan; d. A policy of title insurance, which policy shall be a Lender's ALTA Form 1 Coverage policy of title insurance in the full amount of the City Loan in content satisfactory to City, insuring Borrower's fee interest in the Property, and also insuring that the City Deed of Trust is a third lien on the Property. The policy of title insurance shall be issued by First American Title Company, shall contain such special endorsement(s) as City may require, and shall be subject to no exceptions other than those specifically approved by City; e. Management Agreement with the Marin County Housing Authority as the management agreement; f. A copy of Borrower's corporate resolution authorizing the City Loan; and g. Such other documents as may be required by this Agreement or as City may otherwise require prior to closing. (All of the above documents in this Section 1.03 are herein sometimes referred to collectively as the "the City Loan Documents"). SECTIiiN; TWO: ADCITIONAL COVENANTS. REPRESENTATIONS AND WARRANTIES OF BORROWER Borrower covenants, represents and warrants to the City as follows: 34d:Loanagmt.CSR 3 (6/22/89) 2.01 Use of the Citv Loan Proceeds,. The City Loan proceeds will be applied solely and exclusively to costs relating to the acquisition of the Property. 2.02 Very Low and Low Income Tenants,. Borrower covenants and agrees that as units become available for occupancy, Borrower shall rent, or hold available for occupancy, no less than twenty-five percent (25%) of the units in the Project to Low Income Households on a continuous basis for so long as the City Loan remains outstanding or until December 31, 2005, whichever is longer. Borrower agrees to execute and record the Below Market Rate Rental Unit Agreement, in the form attached as Exhibit "B", the terms of which are incorporated by this reference herein. 2.03 Manaaement Aqreement. The Project shall be managed by the Marin County Housing Authority. Borrower shall not contract with a different management agent for the Project without the prior written approval of City. 2.04 Taxes. If the real property taxes and assessments are assessed against the Property, Borrower shall pay all such taxes and assessments and shall, upon request, furnish City with satisfactory evidence of payment of all such taxes and assessments at least ten (10) days before the same become delinquent. 2.05 Leases. No leases of all or any portion of the Property of more than one year's duration shall be entered into by Borrower without the prior consent of City. Borrower shall, if requested, provide City with the form of lease for the City's approval. 2.06 Orqanization of Borrower. Borrower is a duly organized corporation, validly existing and in good standing under the laws of the State of California. Borrower has all requisite power and authority in the State of California to own and operate its properties within the State to carry on its business as now conducted, and to own or hold under lease its properties, and to execute, deliver and perform this Agreement, the Note, City Deed of Trust and other City Loan Documents. 2.07 Authorization of Loans. The execution, delivery, and performance of this Agreement, the Note, City Deed of Trust and other City Loan Documents have been duly authorized by Borrower; this Agreement, the Note, City Deed of Trust and other City Loan Documents have been duly executed and delivered and constitute the valid and binding obligations of Borrower enforceable in accordance with their respective terms. SECTION THREE: DEFAULT AND REMEDIES 3.01 Events of Default. The occurrence of any of the following events shall, at the option of City, constitute an event of default by Borrower under the terms of this Agreement, the Note, City Deed of Trust and all other City Loan Documents: a. Borrower fails to pay, within sixty (60) days after the date when due, any principal and Contingent Interest payment, or other sums due under this Agreement, or under the Note or any extension or renewals thereof; 34d:Loanagmt.CSR 4 (6/22/89) b. Borrower fails to comply with and fully and timely perform or fulfill any of the obligations or conditions of this Agreement, the City's regulatory agreement, if any, or any other City Loan Documents; C. City fails to have a legal, valid, binding and enforceable lien acceptable to City on the Property encumbered by City Deed of Trust; d. Unless agreed to in writing by City, Borrower voluntarily or involuntarily sells, transfers, disposes of or further encumbers, or agrees to sell, transfer, dispose or further encumber all, or any portion, or any interest in Property or improvements thereon, or in the event Borrower is divested of any interest in Property or improvements thereon or any part thereof by operation of law; e. Material injury or destruction of the Property or improvements thereon, by fire, other casualty or otherwise, which shall not have been immediately repaired to the condition prior to such damage or destruction; f. Death, insolvency, failure in business, commission of an act of bankruptcy, general assignment for the benefit of creditors, filing of any petition in bankruptcy or for relief under the provision of the Bankruptcy Act or any act for the relief of debtors, appointment of a receiver, trustee or liquidator for the Property, admission in writing of an inability to pay debts as they mature, adjudicated as bankrupt or insolvent, dissolution or liquida- tion under law or statute, by or against Borrower; or g. Default under the loans secured by the first, second, fourth or•fifth deeds of trust on the Property or improvement thereon or a breach or default under any document relating to such loans secured by such deeds of trust. 3.02 Remedies of City upon Default. Upon the occurrence of an event of default or any other default by Borrower in the performance of this Agreement or any of the City Loan Documents, City shall have the following rights, in addition to the City's other rights and remedies provided by law: a. If City so elects, its obligations to make the City Loan shall terminate, and City may declare the entire principal amount of the City Loan to become immediately due and payable, and upon doing so, City shall have full power to exercise any and all rights and powers granted to City in the Note, City Deed of Trust and other City Loan Documents in the event of default. The City may, at its option, take possession of the Property securing the City Loan, together with all materials, equipment and improvements thereon, pursuant to the rights given to City under City Deed of Trust. c. The City may terminate this Agreement. 3.03 Nonwaiver by City. No waiver by City of any breach of a covenant, warranty or other event of default shall constitute a waiver of the right of City to assert any future remedies provided for in this Agreement or any other City Loan Document on the basis of the same or a similar breach of a covenant or warranty or other event of default. 34d:Loanagmt.CSR 5 (6/22/89) SECTION FOUR: GENERAL PROVISIONS 4.01 Assiqnment. Neither the City Loan, nor any part thereof shall be assignable by operation of law or by Borrower without the prior written consent of City. This Agreement is made for the sole protection and benefit of Borrower and City, and no other person shall be deemed to have a right of action of any kind hereunder or any claim to the City Loan proceeds. 4.02 Governinq Law. This Agreement and all other City Loan Documents shall be construed according to the laws of the State of California. 4.03. Notice. Any notice required by or given pursuant to this Agreement shall be made in writing and shall be served personally or sent by certified mail, return receipt requested: (a) to City, addressed to: City of San Rafael 1400 Fifth Street San Rafael, California 94901 Attention: Pamela J. Nicolai, City Manager (b) to Borrower, addressed to: Marin Housing Development Corporation c/o Marin City Housing Authority 30 North San Pedro Road San Rafael, California 94913 Attention: Janet M. Schoder, Executive Director with a copy to: Bay Conservation and Development Corporation 30 Van Ness Avenue, Suite 2011 San Francisco, California 94102 Attention: Joan L. Lundstrom Any notice given in accordance with the provisions of this Section shall be deemed to be effective, if delivered, on the date of such delivery or, if mailed, on the date signed for or on the date refused. Each party may give notice to each of the parties of a change of its address for the purposes of giving notice under this Section. 4.04 Amendments. This Agreement may be changed only by an agreement in writing and signed by the party against whom enforcement of any waiver, change, modification or discharge is sought. 4.05 Further Assurances. The parties agree, from time to time and as may be reasonably required by any party hereto, to execute and deliver such further documents and do all matters and things which may be necessary to carry out the intention of this Agreement more effectively and completely. 4.06 Headinqs. The headings to the various sections and paragraphs of this Agreement have been inserted for convenient reference only and shall not be used to construe this Agreement. 34d:Loanagmt.CSR 6 (6/22/89) 4.07 City Not a Joint Venturer. Notwithstanding anything to the contrary herein contained, City, by entering into this Agreement or by any action taken pursuant hereto, will not be deemed a partner or joint venturer with Borrower. Whereas the parties have executed this Agreement as of the date first written above. BORROWER: CITY: Approved as to Form: ity Attorney / MARIN HOUSING DEVELOPMENT CORPORATION, a California nonprofit corporation B y : C , Joh Landstrom, President CITY OF SAN RAFAEL, CALIFORNIA, a public entity By: Paa icorai , eft Manager (Type name and title) ATTEST: Jeanne .�eonci ni , iy C1 erk 34d:Loanagmt.CSR 7 (6/22/89) Exhibit "A" LEGAL DESCRIPTION All that certain real property situate in the City of San Rafael, County of Marin, State of California, described as follows: LOTS 21, 22, 23 and 24, in Block 7, as shown on that certain map entitled, "Map of East San Rafael, Marin Co., Cal.", filed for record January 21, 1908 in Volume 2 of Maps, at page 109, Marin County Records. Recording Requested By & When Recorded Mail To: City of San Rafael 1400 Fifth Street San Rafael, CA 94913 Attn: City Manager BELOW MARKET RATE RENTAL UNIT AGREEMENT THIS AGREEMENT is made as of this 24th day of July, 1989, by and between the City of San Rafael, California, a public entity (the "City") and Marin Housing Development Corporation, a California nonprofit corporation (the "Owner"). This Agreement is entered into on the basis of the following facts, intentions and understandings of the parties: A. Owner desires to acquire an existing 28 -unit rental housing project (the "Project") located at 95 Medway, San Rafael, Marin County, California (the "Property"), more particularly described in Exhibit "A" attached hereto and incorporated herein. B. To provide additional financing for the acquisition of the Property, Owner has obtained a loan from the City from the City's Low Income Housing Fund which requires a certain percentage of the units in the Project to be rented to Low Income Households as more fully set forth herein. C. Owner will acquire the Property with the financial assistance provided by the City which would not have been provided but for the covenants of the Owner set forth herein. In order to induce the City to make its loan to Owner and for other valuable consideration the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Tenant Selection. For as long as the City loan to the Owner remains outstanding or until December 31, 2005, whichever is longer (the "Required period"), but only for so long as the Project is not subject to any Rent Control Law, tenant selection for at least twenty-five percent (25%) of the units in the Project shall be based on income eligibility for Low Income Households, as defined below. "Low Income Household" shall mean the occupant(s) of a residential unit in the Project whose aggregate adjusted household income does no' exceed eighty percent (80%) of the Median Gross Income for the Area, adjusted for household size. "Median Gross Income for the Area" shall mean income for households of an applicable size in the San Francisco PMSA (Primary Metropolitan Statistical Area) most recently determined by HUD, adjusted for household size. 2. Tenant Qualification. Low Income tenant status for the Project shall be determined at the time of initial occupancy of a unit by the tenant and re -certified annually on the basis of a Tenant Income Certification (in the form attached hereto as Exhibit "B") executed by the Low Income tenant and accompanied by a copy of : (i) tenant's federal income tax return for the immediately prior tax year; or 34d.BMR.agr 5.Y �1� (7/21/89) (ii) tenant's employer's verification of current income; or (iii) if the Low Income tenant is self-employed or the tax return is unavailable, such other satisfactory evidence of income. (iv) If a Low Income tenant certifies that he/she did not file or did not retain a copy of tenant's federal tax return, then other evidence such as a current wage statement or employer records must be obtained. 3. Occupancy. Throughout the Required Period, twenty-five percent (25%) of the units in the Project shall be occupied and at all times be rented to Low Income tenants. No Low Income tenant shall be denied continued occupancy, because the tenant's income exceeds the Low Income limits after initial occupancy. If, as of the most recent Tenant Income Certification, it is determined that the income of the Low Income tenant exceeds one hundred and forty percent (140%) of the Median Gross Income for the Area, then that tenant shall no longer qualify as a Low Income tenant. The Owner shall provide the next available unit of comparable or smaller size to a Low Income tenant, as needed to achieve compliance. 4. Reporting. Prior to initial occupancy and each year thereafter, owner shall obtain from each Low Income tenant a Tenant Income Certification and shall maintain the Tenant Income Certification on file for a period of not less than three (3) years. A copy of the Tenant Income Certification shall be submitted to the City with the Owner's Certification of Continuing Compliance (in the form attached hereto as Exhibit "C"). Owner shall submit to the City a copy of the Certification of Continuing Compliance within three (3) months after Owner acquires title to the Property and semi-annually thereafter for the Required Period. Owner shall permit the City or its authorized representatives or designees to inspect the Project records upon reasonable notice. 5. Covenants. It is intended and determined that the provisions of this Agreement shall constitute covenants which shall run with the land comprising the Project for the benefit thereof, and the burdens and benefits thereof shall bind and inure to the benefit of all successors in interest of the parties hereto. 6. Notices. Any notice required by this Agreement shall be served personally or sent by first class mail as follows: (a) City of San Rafael 1400 Fifth Avenue San Rafael, California 94901 (P.O. Box 60, San Rafael, California 94915-0060) Attention: City Manager (b) Marin Housing Development Corporation 30 North San Pedro Road, Suite 265 San Rafael, California 94903 (P.O. Box 4282, San Rafael, California 94913-4282) Attention: Joan L. Lundstrom, President (c) with a copy to Owner's Management Agent: Marin City Housing Authority 30 North San Pedro Road, Suite 265 San Rafael, California 94903 (P.O. Box 4282, San Rafael, California 94913-4282) Attention: Executive Director 34d.BMR.agr 2 (7/21/89) Any notice given in accordance with the provisions of this section shall be deemed to be effective, if delivered, on the date of such delivery or, if mailed, three (3) days after the posting date. Each party may give notice to each of the parties of a change of its address for the purposes of giving notice under this Section. Whereas the parties have executed this Agreement as of the date first written above. OWNER: MARIN HOUSING DEVELOPMENT CORPORATION; a California nonprofit corporation By: ('C n L. Lundstrom, President CITY: CITY OF SAN RAFAEL, CALIFORNIA, a public entity �A%proved as to Form: 8y: ame a . 1%�oa,`�ety anagen CityAtforne y ATTEST: State of California County of 1�z�.v m ss . nne M. Leoncin<,Ml tyClerk On July 2D, 1989, before me, the undersigned, a Notary Public in and f9r said State, personally appeared Joan L. Lundstrom, President, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person who executed this instrument as the President on behalf of the Corporation named therein and acknowledged to me that the Corporation executed it. OFFICIAL. SEAL WITNE m ha and official seal. B GAEBLER NOTP.-^:Y PUBLIC - CALIr04 i MARIN COUNTY It MY Comm. UPIres LUN 4;• 1WV State of California County of Marin } ss On July - 4-, 1989, before me, the undersigned, a Notary Public in and for said State, personally appeared Pamela J. Nicolai, City Manager, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person who executed this instrument as the City Manager of the City of San Rafael, California, and acknowledged to me that the City of San Rafael executed it. :•� �FVICIaf, t' WITNESS my hand and official seal. 1EFc���dE F. LEOS��I�!i " NOTARY PUBLIC - CALIFORNIA • _ MAR!N COUNTY \ �; Y:7 Comm. Expi�s Nov. 29, 1991 34d.BMR.Q%j `-'x�w,----- 3 (7/20/89) 1400 - 5th kee.• P.O. Bax 60, San Raf-aei, CA 95915-0060 Exhibit "A" LEGAL DESCRIPTION All that certain real property situate in the City of San Rafael, County of Marin, State of California, described as follows: LOTS 21, 22, 23 and 24, in Block 7, as shown on that certain map entitled, "Map of East San Rafael, Marin Co., Cal.", filed for record January 21, 1908 in Volume 2 of Maps, at page 109, Marin County Records. UI -LU EXHIBIT �� ►► CITY OF SAN RAFAEI, BELOW MARKET RATS RENTAL UNIT AGREEMENT PROJECT : OWNER : APARTMENT NO. TENANT/HOUSEHOLD NAME : TENANT INCOME CERTIFICATION last ADDRESS : MONTHLY RENT : first TOTAL CURRENT HOUSEHOLD GROSS ANNUAL INCOME : (total household income includes all wages, salaries, et., as reported as gross income for federal income tax-) Attached hereto ars: federal or state income tax returns, stubs from paychecks or other evidence of the income of the persons listed below. Name of Member of -the Relation- Social Place of Household ship Age Security No. Employment I/We the undersigned have read and answered fully, frankly and personally each of the above questions under penalty of purjury and do hereby swear they are true. Tenant - Head of Household Owner Date Date EXHIBIT TV1 CITY OF SAN RAFAEL BELOW MARKET RATES RENTAL UNIT AGREEMENT CERTIFICATION OF CONTINUING COMPLIANCE PROJECT : OWNER : TOTAL UNITS : TOTAL LOW INCOME UNITS : ADDRESS : TOTAL MODERATE INCOME UNITS : _ N/_....____.. The undersigned, in accordance with the BELOW MARKET RATE RENTAL UNIT AGREEMENT with the City of San Rafael dated for -the Project does hereby certify that during the preceding twelve (12) months, the following units were occupied in accordance with the Below Market Rate Rental Unit Agreement and does hereby further certify that the representation set forth herein are true and correct to the best of the undersigned's knowledge. Low Income Unit Monthly Annual Household Tenants Name No. Rent Income size Signed . :late Owner Attach additional sheets if necessary.