Hr Manager Na

SEATTLE MFTE/IZ EMPLOYMENT VERIFICATION

THIS SECTION TO BE COMPLETED BY MANAGEMENT AND SIGNED BY RESIDENT

This form must be mailed, faxed, or emailed to the residents employer by on-site personnel. The resident

cannot "hand carry" this form to his/her employer.

TO: Name & Address of Employer X 1st Request

2nd Request

X 2nd Request

3rd Request

Fax #: Attn: HR/ Supervisor

Re: 211

Applicant/Resident Name Social Security Number Unit # (if assigned)

I hereby authorize release of my employment information.

Signature of Applicant/Resident Date

The individual named above is an applicant/resident to the City of Seattle Multifamily Tax Exemption (MFTE) and/or Incentive Zoning

affordable housing unit that requires verification of income. The information provided will remain confidential to satisfaction of that stated

purpose only. Your prompt response is crucial and greatly appreciated.

Return Form To:

Alyssa Arneson Alyssa Arneson

Management Agent ********@**********.***

206-***-**** 206 5th Ave N

Phone Number Seattle WA, 98109

THIS SECTION TO BE COMPLETED BY EMPLOYER

*Please use GROSS amounts and do not leave any section blank; enter zero "0" or "N/A"*

Employee Name: Elisha Burton Job Title: Paratransit Driver

Presently Employed: Yes x Date First Employed: 4/25/2022

No Last Date of Employment:

Current Gross Wages/Salary: $ 19.50 Average # of regular hours per week: 40

x hourly weekly bi-weekly monthly semi-monthly yearly other

Year-to-date gross earnings: NA from 4/25/2022 through 5/3/2022

mm-dd-yy mm-dd-yy

# of Pay Periods included in YTD: incompl

Overtime Rate: NA per hour Avg # of overtime hours per week: NA

Shift Differential Rate: NA per hour Avg # shift differential hours per week: NA

Commission, bonuses, tips, other: NA Included in YTD figure above? Yes No

hourly weekly bi-weekly monthly semi-monthly yearly other

List any anticipated increase in the employee's rate of pay within the next 12 months: NA

Effective date of increase: NA

Does the employee participate in a 401(k) Retirement account? Yes No

Can the employee access the 401(k) acount? Yes No

If the employee work is seasonal/sporadic, please indicate the layoff period(s): NA

If no Social Security number was provided, did employer view picture identification? x Yes No

SMR Susan M. Robinson, HR Manager 5/3/2022

Employer's signature Employer's Printed Name and Title Date

MV Transportation, Inc. *****.********@*********.*** 253-***-**** NA

Employer (Company Name) email Address Phone # Fax #

http://www.seattle.gov/housing/housing-developers/multifamily-tax-exemption

Seattle MFTE/IZ Employment Verification Request I Rev. April 2016

Contact this candidate