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✓ � I <br /> � ,, t II <br /> a <br /> Part III: Determining income eGgibility I <br /> 18. Maximum income limit for a family of 18. � <br /> 19. Total adjusted gross income (line 17) 19. <br /> 20. Difference(line 18 minus line 19) 20. I <br /> If line 20 is greater than zero,the household is eligible. ', <br /> If line 20 is less than or equal to zero,the family is not eligible. <br /> UWe certify that the above information is correct. UWe have been advised that any <br /> misrepresentation or misstatement throughout my/our loan application process may be a violation <br /> of law that could result in a fine, criminal penalty or immediate repayment of my/our loan. <br /> Borrower Date Co-Borrower Date <br /> Based on a review of source documentation, the Program has completed an income eligibility <br /> analysis and has determined that the household is is not eligible <br /> for assistance. I further certify that the information contained in this certification is true and <br /> accurate to the best of my knowledge. <br /> Signature of Reviewer <br /> Name <br /> Date <br /> Note: Attach source documents used for the review. <br /> D-2 <br />