HomeMy WebLinkAboutExhibit 4EXHIBIT "B"
INCOME AFFIDAVIT FORM
(Affordable Housing Units)
I (We) , do hereby certify that
my (our) income for last year is either lat or below (a) 50%, or (b) 80%, or (c)
120% of the Miami -Dade County median income. I (We) fully understand that the
City of Miami, , as the Developer, and
Title Insurance Company are relying on this certification in
order to release Unit of Phase of the Wagner Square Condominium from
the Declaration of Restrictions recorded March 22, 2005, in Official Records Book
23191, Pages 1541-1546 of the Public Records of Miami -Dade County, Florida, as
amended.
Buyer
Buyer,
STATE OF FLORIDA )
COUNTY OF )
BEFORE ME, .the undersigned authority, personally appeared
, who is (are) personally known to
me or has (have) produced satisfactory evidence of identification and did take an oath,
and who after first being duly 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
, 200_ by
My Commission Expires:
NOTARY PUBLIC
State of Florida at Large
Print Name:
ors:Document 87915