12-103119 AP # (2- tO ( ( 1
AilI" CITY OF CITY HALL
Federal Way8th Avenue South Federal
al Way,WA 98003-6325
(253)835-7000
www.cityoffederaiway.com
July 6,2012
To Whom It May Concern:
The City of Federal Way has reviewed the Purchaser Income Verification Form and has
determined that the prospective purchaser falls within the acceptable guidelines for a moderate
income household.
Sincerely,
C
Isaac Conlen,Planning Manager
Community and Economic Development Department
•
2012 HALM.Income'Levels by Household Size.
7ihe!folfowin9cfrurt is only mtendc.da:as•sbmatC of alto rdabfe:rentsandthams price. Based onprc5ent corxldrons_-Current-conditions,
.+nd part icufar circums[once,will be,taken mtr,,rccount in deterininhrig actaa Iafforda bk.rents and home prices.See notes below for detai�l orf-yay55umptions about present�coinditions.
Y) -i-- 3
='• t'"k.,..-1 c 'S,•'':fc.L'_'rxi._ii. j- ' 'no,aa... f wA�,yy- '.+ sea AS /. i
300/6 10,5170 ,5 21,150 $ 22,21a $ 23,8011 ,. 26,-1013 .• 28,550 30,650'
Affordable H Payment*** $ 385 $ 441 !lttl
p $ 463 $ 496 $ 550 $ 595 $ 639
Affordable Rent $ 463 $ 529 g 555 g 595 g 660 g 714 $ 766
Affordable House Price*** 84 500 96,600 101 500 108 700 120 600 130 400 140,000
400/ 5. 24,6.-10 5 23,160 ^'. 29,563 3 31,680" ) ,5,210 '4 38,040 $ 40,810
f
Affordable Hag Payment I $ 513 $ 587 $ 616 $ 660 $ 733 $ . 793 $ 851
Affordable Rent $ 616 $ 704 $ 739 I $ 792 $ 880 $ 951 $ 1,021
Affordable House Price 11 600 128 700 135 100 144 700 160 800 173 800 186 600
50% 5 ,0,800 a 15,200 - 36,060 39,600 5 44,000 , 47,550 ;',-. sl,oso-
Affordable Hap Payment $ 642 g 733 770 $ 825 $ 917 $ 991 $ 1,064
Affordable Rent $ 770 $ 880 $ 924 g 990 $ 1,100 $ 1,189 $ 1,276
Affordable House Price 140 700 160 800 168 900 180 900 201000 217 200 $233 200
60% '4. ,"6,560 '5 -12,2-10 $ 44,352 4 47,520 5 52,800 y 57,060 5 6Y,260-
Affordable Hag Payment. $ 770 $ 880 $ 924! $ 990 $ 1,100 $ 1,189 $ 1,276
Affordable Rent $ 924 $ 1,056 $ 1,109 { $ 1,188 $ 1,320 $ 1,427 $ 1,532
Affordable House Price 168 900 193 000 202 600 It 217 100 241 200 260 700 279 900
70% ) 43,120 49,280 $ 52,744 3 55,440
> 61,600 'S 66,570 '9 71,4/0
Affordable Hsu Payment , $ 898 $ 1,027 $ 1,078 $ 1,155 i $ 1,283 $ 1,387 $ 1,489
Affordable Rent $ 1,078 $ 1,232 11 $ 1,294 g 1,386 $ 1,540 $ 1,664 $ 1,787
Affordable House Price 197 000 225 100 ( 236 400 253 300 ( 281 400 304 100 26 500
80°/n(capped)'" 5 45,500 52,000 $ 54,600 '5 58,500 i 65,000 -5 70,200 y /5,400
Affordable Ham Payment $ 948 $ 1,083 $'. 1,138 $ 1,219 $ 1,354 I $ 1,463 $ 1,571
Aflbrdable Rent $ 1,138 $ 1,300 $ 1,36S $ 1,463 I $ 1,625 $ 1,755 $ 1,885
Affordable House Price 207 900 237 600 49 400 267 300 297 000 20 700 44 500
30%(not capped) 3 -19,2u0 , -6,320 $ 59136 S 63,360 3 /0,400 76,050 '5 81,680
Affordable H so Payment ( $ 1,027 g 1,173 $ 1,232 $ 1320 $ 1,467 $ 1,585 $ 1,702
Aflbrdeble Rent $ 1,232 $ 1,408 $ 1,478 g 1,584 $ 1,760 $ 1,902 $ 2,042
Affordable House Price 225 100 257 300 270 200 289 500 21 600 7 600 73 200
90°10 55,-430 , 63,_;611 t3 66,52c,' 2 n c
'; /1,280 /9,200- 't 85,_`, O 4 T1,850
Affordable Ned Payment $ 1,155 $ 1,320 $ 1,386 $ 1,485 $ 1,650 $ 1,783 $ 1,914
Affordable Rent $ 1,386 $ 1,584 $ 1,663 $ 1,782 $ 1,980 g,. 2,140 $ 2,297
Affordable Hoarse Price 253 .. 289 500 303 900 325 600 . 61800 391000 19 800
tow'''. 'S 6i,,Co -, 70,4)00 $ 73,920 y 19,200 > 88,000 ) 95,I00 'i 102,100
Affordable 14erp Payment $ 1,283 $ 1,467 $ 1,540 $ 1,650 $ 1,833 $ 1,981 $ 2,127
Affordable Rent $ 1,540 $ 1,760 1 $ 1,848 $ 1,980 $ 2,200 $ 2,378 $ 2,553
Affordable House Price 281 400 21 600 37 700 361 :"' ' 000 434 500 •• 400
11511/c, 'r /0,H40 10,960 $ 135,1308 ' 91,080 S 101,?OQ 'g. 109,365 "� 2t7,915
Affordable Hag Payment I I$ 1,476 $ 1,687 1 $ 1,771 $ 1,898 $ 2,108 $ 2,278 $ 2,446
Affordable Rent g 1,771 g 2,024 $ 2,125 (g 2,277 , $ 2,530 $ 2,734 $ 2,935
Affordable House Price I 323 600 69 900 I 388 400 416,100 ( • 300 .. 600 536 400
120/n 3 /3,920 j 24,-180 $ 88,704 'y 95,040 5 105,600 $ 114,120. } 122,520
Affordable Hsu Payment $ 1,540 I $ 1,760 I $ 1,848 $ 1,980 $ 2,200 f g 2,378 ( $ 2,553
Affordable Rent I $ 1,848 $ 2,112 2,218 $ 2,376 I 2,640 $ 2,853 * 3,063
Affordable House Price 37 700 386 000 15 200 I 34 200 : 400 I 521 400 559 700
EXHIBIT B
Purchaser Income Verification Form
THE RESTRICTED UNIT you are purchasing �DUItGt , Los! or 12, lie K, 2
[PA)t a and Address of Unit!
win �ireIQ Sur a e Fedodwav, Au, - Hinz 3
is located within THE PALISADES AT DASH POINT Condo inium and is subject to the
terms of a restrictive covenant for the condominium project. Pursuant to this covenant,
your unit is to be available only to moderate income households. The covenant requires
that the seller provide Income Verification Forms to the City of Federal Way to assist the
City in monitoring compliance with the conditions of the restrictive covenant.
Consequently,all purchasers are required to complete this Income Verification Form for
submittal to the City of Federal Way. The information will not be used for any other
purpose than determining financial qualifications as purchasers under affordable
housing restrictions imposed by the City of Federal Way and meeting the recording
requirements of the City of Federal Way and will remain confidential.
Purchaser: Co-Purchaser:
Gross Employment Income f P. (rap Gross Employment income
1 Commissions Commissions
�r Dividends/Interest Dividends/Interest
Net Rental Income ( _Net Rental Income
Other Income Q..„ ,- Other Income q'2JO ,—
•
TOTAL < r' �J �� 2 TOTAL -( - 3t
Describe other income: So//d Pam& l4. ..Zif(-erne-
Alimony,child support or separate maintenance income is considered income.
•t0•
:.SERVERW}A3S.ycontPafisacae41e aradon 3.doc 05'72x02( l99329.SG I
Does any other individual who will be tMng in the condominium receive income from any source?
❑ Yes L�Flo
If yes,please describe the type,timing and source of this income:
TOTAL Household income at the time of purchase:
Household Size at time of purchase: No.of Adults:
No.of Children:
AGREEMENT -
The intorrnatioi i contained in the Income Verification Form is provided to assist the
Seller and the City of Federal Way in monitoring compliance with the requirements of
the Restricted Covenant for Affordable Housing. Each undersigned understands that
the Seller and the City of Federal Way are relying on the information provided on this
form and assert that the information is true and correct.
44. Purchaser
�c-J� Wi /�/ Z
Date
o721/La12___
-purchaser Date
Please attach copies of your most recent tax return or the mortgage application showing
gross income.
L -11
tt_SERvt tFvdestt•,conlPalisades',deckraurn s aoc C6112J2002 Opt)$9389.001