Form Dhs-2 - Application Forassistance - Rhode Island Department Of Human Services Page 17
Download a blank fillable Form Dhs-2 - Application Forassistance - Rhode Island Department Of Human Services in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Dhs-2 - Application Forassistance - Rhode Island Department Of Human Services with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
DHS-2 Rev. 10-14
Page 13
Did you, your spouse, or anyone in the household receive a
15a
Social Security, Retirement, Survivors and Disability (RSDI)
Yes
lump sum in the past 6 months?
No
If yes, complete box below.
Last Name
First Name
Middle Initial
Amount received
Date received
$
/
/
Do you, your spouse, or anyone in the household own, and/or
16
Yes
have registered in his/her name any vehicle such as the types
No
listed below?
EXAMPLES:
Car
Boat
Truck
Motorcycle
Camper
Snowmobile
Recreational Vehicle
If yes, complete the boxes below for each vehicle.
C A R S
Owner’s Last Name
First Name
Middle Initial Vehicle
Make
Model
Year
Blue book value
$
What is the vehicle used for?
Amount owed
Vehicle ID Number
Registration Number
(ex:
work, everyday use, transportation for
disabled household member)
$
Insurance Company
Owner’s Last Name
First Name
Middle Initial Vehicle
Make
Model
Year
Blue book value
$
Amount owed
Vehicle ID Number
Registration Number
What is the vehicle used for?
(ex:
work, everyday use, transportation for
disabled household member)
$
Insurance Company
Owner’s Last Name
First Name
Middle Initial Vehicle
Make
Model
Year
Blue book value
$
What is the vehicle used for?
Amount owed
Vehicle ID Number
Registration Number
(ex:
work, everyday use, transportation for
disabled household member)
$
Insurance Company
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal