HomeMy WebLinkAboutExhibit 4EXHIBIT "C"
INCOME AFFIDAVIT
(Work Force Housing Units)
I (We) , do hereby certify that my (our)
income for last year is either at or below (a) 150%, or (b) — 170% of the Miami -Dade
County median income. I (We) fully understand that the City of Miami, the Developer, and the
Title Insurance Company are relying on this certification in order to release Unit of Phase
of the Wagner Square Condominium form the Declaration of Restrictions.
Buyer
STATE, OF FLORIDA
COUNT` .:. F )
ORE ME, the undersigned ( t4thority, personally appeared
, who`i (are) personally known to me or has
(have) produced satisfactory evidence of identification and `did take an oath, and who after first
being dul+.`sworn, did depose and state that the foregoing Income Affidavit is true and correct to
the best of his/her knowledge and belief.
SWORN TO AND SUBSCRIBED before me this' day of , 2005
by
My Commission Expires:
ors:Document 860 (2)
NOTRY PUBLIC
State of Florida at Large
Print Name:
1