Income and Household Information
Please list all sources of income for the entire household. This includes wages, alimony, child support, social security, etc, whether it is for you, your spouse, children, or other people living in the same house. lf you need additional space, use another sheet.
You must submit proof of income by providing copies of the 2009 1040 tax form OR proof of state/federal benefits (social security, unemployment, SSI, medical card, etc.), or any pension benefits. W-2 statements alone will not be accepted.