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Any other family member who is under 18 years of age (or 18 and in secondary school) but must include any unearned income. NAME INCOME SOURCE: WAGES, SOCIAL SECURITY, etc. AMOUNT Yearly RECEIVED (Check One) Monthly Weekly 1. 2. 3. 4. 5. 6. SECTION FOUR Applicant Notification and Signature The individual signing this application may be asked to prove any or all of your statements. If we ask you to do this, we will tell you how to prove your statements. We are asking for Social Security num.

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