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CITY OF ORONO, MINNESOTA <br /> By: <br /> Its Mayor <br /> By: <br /> Its City Clerk <br /> STATE OF MINNESOTA ) <br /> ) ss <br /> COUNTY OF HENNEPIN ) <br /> The foregoing instrument was acknowledged before me this day of <br /> , by and <br /> , the Mayor and City Clerk of the City of Orono, <br /> Minnesota, a municipal corporation under the laws of the State of Minnesota, on <br /> behalf of the city. <br /> Notary Public <br /> ml:796288.01 796288.03 <br /> EXHIBIT E <br /> Form of Income Certification <br /> Certification of Tenant Eligibility <br /> UNIT NUMBER: <br /> I/We, the undersigned, being first duly sworn, state that I/we have read and <br /> answered fully and truthfully each of the following questions for all persons who are <br /> to occupy the unit in the Orono Woods Apartments development for which <br /> application is made, all of whom are listed below: <br /> 1.2.3.4.5.Name of Members of the Household Relationship to Head of Household Age <br /> Social Security Number Place of EmploymentHead - - Spouse - <br /> Income Computation <br /> 6. Anticipated Annual Income. The anticipated total annual income from all <br /> sources of each person listed in item 1 above for the twelve month period beginning <br />