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(a) (2) and (3) Household source of income can only be Social Security Benefits Person applying does not qualify if ANYONE in the household is employed, collecting unemployment, alimony, child support, or has any other source of income. WATER/REFUSE Bill must be paid in FULL WATER/REFUSE Bill has to be in the person s name applying for assistance Applicant MUST reapply every calendar year beginning January 1. Instructions 1. Read the application carefully. If you meet all the qual.

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