Pbv Application Packet - Housing Authority Of Snohomish County Page 12
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38C. FAMILY INCOME
Source of Income (include Phone and
Gross Monthly
Family Member Name
Type of Income
Fax/Email)
Income (before taxes,
deductions)
$
$
$
$
1. Is there any household member who is under 18 and has a job?
Yes
No
If yes, please list name and birthdate:
1. Is there any household member 18 or older who is claiming NO INCOME?
Yes
No
If yes, please complete a No Income Statement for all those who meet these criteria.
2. Does anyone who does not live in the household pay bills on your behalf or give you
Yes
No
money or material goods on a regular basis?
If yes, please list the name and contact information:
4. Are you or any family member participating in a job-training program?
Yes
No
If yes, please list the agency name and phone number:
Must provide supporting documentation for income. Refer to VERIFICATION REQUIREMENTS.
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