2019 RRP Application Form - Laserfiche WebLink

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Last Name & Sr, Jr, etc. First Name MI Date of Birth Sex Relation 2 Race (select one or more) Ethnicity (check one box) \[ \] White \[ \] Asian \[ \] Black or African American \[ \] Hispanic or Latino \[ \] Native Hawaiian or Other Pacific Islander \[ \] Not Hispanic or Latino \[ \] American Indian / Alaska Native Name & Sr, Jr, etc. First Name MI Date of Birth Sex Relation 3 Race (select one or more) Ethnicity (check one box) \[ \] White \[ \] Asian \[ \] Black or African American \[ \] Hispanic or Latino \[ \] Native Hawaiian or Other Pacific Islander \[ \] Not Hispanic or Latino \[ \] American Indian / Alaska Native Last Name & Sr, Jr, etc. First Name MI Date of Birth Sex Relation 4 Race (select one or more) Ethnicity (check one box) \[ \] White \[ \] Asian \[ \] Black or African American \[ \] Hispanic or Latino \[ \] Native Hawaiian or Other Pacific Islander \[ \] Not Hispanic or Latino \[ \] American Indian / Alaska Native Last Name & Sr, Jr, etc. First Name MI Date of Birth Sex Relation 5 Race (select one ore more) Ethnicity (check one box) \[ \] White \[ \] Asian \[ \] Black or African American \[ \] Hispanic or Latino \[ \] Native Hawaiian or Other Pacific Islander \[ \] Not Hispanic or Latino \[ \] American Indian / Alaska Native Last Name & Sr, Jr, etc. First Name MI Date of Birth Sex Relation 6 Race (select one or more) Ethnicity (check one box) \[ \] White \[ \] Asian \[ \] Black or African American \[ \] Hispanic or Latino \[ \] Native Hawaiian or Other Pacific Islander \[ \] Not Hispanic or Latino \[ \] American Indian / Alaska Native PART 3: ASSET INFORMATION: Please list any checking, savings, stocks, bonds, annuities, savings bonds, credit union shares, trust accounts, retirement contributions, pension contributions, IRAs, certificates of deposit or other assets for everyone in your household. Also include assets that are held jointly with another person and include the joint Family Member Bank/Credit Union/Financial Type of Account Estimated Name Institution Account Number Current Balance PART 4: REAL ESTATE INFORMATION: Please list all real estate owned for everyone for in your household. Family Member Tax Map Key Current Mortgage Monthly Mortgage Mortgagee Name Name Number Assessed Value Balance Payment Loan No. and Address PART 5: LIABILITIES: Please list t otal monthly debt owed; credit cards, car loans, personal loans, etc. except previously listed mortgages. Family Member Account Type Balance Monthly Account No. Creditor Name Name Payment and Address