Form Mc 176 P - Property Reserve Work Sheet Page 2
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1
2PROPERTY RESERVE WORK SHEET—SECTION 1931(b) PROGRAM
Name__________________________________ Case Number ____________________ Month ____________________
COUNTY USE SECTION
A. NONEXEMPT OTHER REAL PROPERTY (ORP)
Determine market value and encumbrances of nonexempt
ORP in county use section and list in 1 and 2. Note: If
nonexempt ORP owned jointly with persons not in the
M F B U , l i s t o n l y t h e s h a r e o f m a r k e t v a l u e a n d
encumbrances of persons in the MFBU.
1. Market Value per Section 50412
$
2. Encumbrances per Section 50413
–$
3. Net Market Value (line 1 minus line 2)
$
4. Life Estate (determine value per Section 50442
and procedure 9A)
$
5. Total net nonexempt ORP
(add lines 3 and 4)—Enter in B.1.
$
B. PROPERTY RESERVE
1. Total net nonexempt ORP from A.5.
$
2. Notes, mortgages, deeds of trust owned by
MFBU member and not producing income
$
3. Nonbusiness liquid assets (money, checking/
savings, stocks, bonds)
$
4. IRAs and accessible KEOGHs
$
5. Burial plots, vaults, or crypts (not for family use)
$
6. Excess revocable designated burial funds
(over $1500)
$
7. Nonexempt vehicles, boats, vans, trailers, etc.
(list items and amounts from MC 176 P-V)
$
$
$
$
8. Other countable property (list items)
$
$
$
$
9. Subtotal property reserve (add lines 1 through 8)
$
10. Long-term care insurance exemption
(benefits paid)
–$
11. Amount equal to Japanese Reparation Payment –$
12. Total property reserve (line 9 minus lines 10 and 11)
$
13. Property limit for MFBU
Number of persons in MFBU ________
$
14. Is line 13 greater than or equal to line 12?
Yes
property eligible
—
No
property ineligible (see below)
—
Did you explain spenddown options to ensure the ability
to get TMC later?
Did you do the Sneede Screen? (See other side.)
If not eligible for the Section 1931(b) program, determine
eligibility for the AFDC-MN program.
MC 176 P (05/07)
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