2016 RRP Application - Laserfiche WebLink

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Last Name & Sr, Jr, etc. First Name MI Date of Birth SexRelation 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 SexRelation 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 SexRelation 4 Ethnicity (check one box) Race (select one or more) \[ \] 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 SexRelation 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 SexRelation 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 holder’s name. Family Member Bank/Credit Union/Financial Type of AccountEstimated Name Institution AccountNumber Current Balance PART 4: REAL ESTATE INFORMATION: Please list all real estate owned for everyone for in your household. Family Member Tax Map Key CurrentMortgage Monthly Mortgage Mortgagee Name Name Number Assessed Value Balance PaymentLoan 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