Rent Calculation
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TENANT NAME: _______________________ UNIT: ______
INCOME:
YEAR ( ) NET INCOME FROM T- 4 $____________
We verify the above net income is shown on the T- 4
Tenant Initial: _____ Masonic Housing Initial: ____
RENT CALCULATION:
NET INCOME X 30% = $_________ DIVIDE BY 12 = $_________
LESS $ 83 HEAT ASSISTANCE = $________
ADD $40 SATELLITE TV = MONTHLY TENANT RENT $ _______
Tenant or Family Member
______________________ Date: ____________
Woodstock Masonic Housing Inc.
______________________ Date: ____________