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B. RESOURCES You do not have to complete this section if you are only renewing for TANF. Otherwise, answer for everyone for whom you are applying. Include any resources anyone owns, or that are jointly owned with someone else, even if that person does not live with you. List the names of all joint owners.

1. Do you or anyone who lives with you have any of the following resources or assets?

Yes No Yes No Yes No   Cash $_________   Checking, Savings   Credit Union   401K, 403B, etc.   Promissory notes   Money Market Funds   Individual Retirement Account (IRA)   Christmas Club   Deeds of Trust   Deferred Compensation Plan   Uniform Gift to Minor Account   Retirement accounts   Keogh Plan   Certificate of Deposit (CD)   Trust funds   Stocks or bonds   Pension plans   ABLE Account   Other ________________________

— If you have any of the above, please provide the following information: a.

Owner Name (last, first, middle initial)

Co-Owner Name (last, first, middle initial)

$ Name of Bank or Institution

Account Type

Account Number

Balance Address of Bank or Institution b.

Owner Name (last, first, middle initial)

Co-Owner Name (last, first, middle initial)

$ Name of Bank or Institution

Account Type

Account Number

Balance Address of Bank or Institution

 YES  NO 2. Has anyone received or expect to receive winnings of $4,500 or more from lottery or gambling? If YES, explain: _________________________________________________________________________________________

 YES  NO 3. Has anyone sold, transferred or given away any resources in the last 3 months (for SNAP), in the last 3 years (for Auxiliary Grants)? If YES, explain: ______________________________________________________________

Note: Additional Resource information may be needed section if you are applying for the Auxiliary Grant program.

C. INCOME 1. Do you or anyone who lives with you receive or expect to receive any of the following types of money from working? Include money from all jobs that you have now or expect to begin full time, part time, seasonal, temporary, self-employment. Answer Yes or No below and provide the requested information:

Yes No Yes No Yes No

  Wages/Salary   Earned Sick Pay   Self-employment

  Contract Income   Babysitting/Adult or childcare   Any other money from

  Vacation Pay   Farming/Fishing

working

  Commissions, Bonuses, Tips   Odd jobs

Name (last, first, middle initial)

Employer Name, Address and Telephone Number

Pay Schedule Number of Hours Per Week

Rate of Pay

 Weekly  Monthly

 Biweekly  Other  Twice a Month Date Job Started

Next Pay Date (mm/dd/yyyy)

Name (last, first, middle initial)

Employer Name, Address and Telephone Number

Pay Schedule Number of Hours Per Week

Rate of Pay

 Weekly  Monthly

 Biweekly  Other  Twice a Month Date Job Started

Next Pay Date (mm/dd/yyyy)

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