Form Mc 175-3i.2r - Section 1931(B) Sneede V Kizer Net Nonexempt Income Determination And Mini Budget Unit (Mbu) Determination-Recipient Page 4

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MBU NUMBER _______
MBU NUMBER _______
Person name/number
Net nonexempt
Person name/number
Net nonexempt
Property
Income
Property
Income
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
6.
6.
TOTAL
TOTAL
MBUs
Property limit
MBUs
Property limit
MBSAC
MBSAC
Check one:
Check one:
Excess property—FAIL
Excess property—FAIL
Income ineligibility—at/exceeds MBSAC—Property eligible—FAIL
Income ineligibility—at/exceeds MBSAC—Property eligible—FAIL
Income eligible—below MBSAC—Property eligible—PASS
Income eligible—below MBSAC—Property eligible—PASS
MBU NUMBER _______
MBU NUMBER _______
Person name/number
Net nonexempt
Person name/number
Net nonexempt
Property
Income
Property
Income
1.
1.
2.
2.
3.
3.
4.
4.
5.
5.
6.
6.
TOTAL
TOTAL
MBUs
Property limit
MBUs
Property limit
MBSAC
MBSAC
Check one:
Check one:
Excess property—FAIL
Excess property—FAIL
Income ineligibility—at/exceeds MBSAC—Property eligible—FAIL
Income ineligibility—at/exceeds MBSAC—Property eligible—FAIL
Income eligible—below MBSAC—Property eligible—PASS
Income eligible—below MBSAC—Property eligible—PASS
Page 4 of 4
MC 175-3I.2R (05/07) 1931 Group

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