HomeMy WebLinkAboutExhibit 5EXHIBIT "C"
INCOME AFFIDAVIT FORM
(Workforce 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,
, 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.
STATE OF FLORIDA )
COUNTY OF )
Buyer
Buyer
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:i
NOTARY PUBLIC
State of Florida at Large
Print Name:
ors:Document 87915