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16. Does anyone have any of the items listed below? Yes No Include assets owned as of the first of the month and assets which are co-owned with anyone who does not live with you. Check “Yes or No” for each item below. Include other assets not listed in blank spaces provided below. FINANCIAL ACCOUNTS YES NO ASSETS NAME OF PERSON(S) ON ACCOUNT NAME OF FINANCIAL INSTITUTION & BRANCH ACCOUNT NO. AMOUNT Checking Accounts: Personal/Business $ Savings Accounts $ Credit Union Accounts $ Christmas Savings $ LIQUID ASSETS YES NO ASSETS NAME OF PERSON(S) ON ACCOUNT NAME OF FINANCIAL INSTITUTION & BRANCH ACCOUNT NO. AMOUNT Cash on Hand $ Tax Refund/Tax Credit $ Stocks/Bonds (savings bonds) $ Money Market/ Time Certificate $ IRA/KEOGH Deferred Comp. $ $ $ OTHER ASSETS YES NO ASSETS PERSON(S) LISTED AS OWNERS LOCATION/ADDRESS OF ITEM MARKET VALUE AMOUNT OWED EQUITY Your Home/Mobile Home $ $ $ Other Houses/Land/ Buildings $ $ $ Agreement of Sale of Real Property $ $ $ Burial Plans/Cemetery Plot $ $ $ Life Insurance-List all Policies $ $ $ Other (Specify, i.e. Jewelry, TV, Radio, Stereo, Musical Instruments, Hobby Items, Etc.) $ $ $ TRANSFER OF PROPERTY 17. Has anyone sold, traded, transferred, or given away money, vehicles, property, or other resources/assets in the last 3 months (If applying for SNAP only), or in the last 24 months (if applying for financial assistance)? Yes No If yes, complete below: ITEM SOLD, TRADED, ETC. DATE REASON FOR SELLING, TRANSFERRING, ETC. ACTUAL VALUE OF ITEM AMOUNT OWED AMOUNT RECEIVED $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ STUDENT INFORMATION 18. Is anyone aged 16 years and older a student? Yes No If yes, complete below: NAME OF STUDENT NAME OF SCHOOL FULL TIME? PART TIME? START DATE MO./DAY/YR. END DATE MO./DAY/YR. 19. Has anyone applied for admission to a college, training, or vocational school? Yes No Name: DHS 1240 (REV 04/2024) Page 5 of 11 Attachment A-2, Page 7 of 18