Palco Enrollment Form English Project Access Lancaster County (Page 4 of 4) in pdf

Palco Enrollment Form English Project Access Lancaster County Page 4

Sources of Proof for PALCO

Do not send Originals. They will not be returned.

Acceptable Proofs of Identification (provide one document below)

• Copy of valid PA driver’s license or PA ID card (can also serve as proof of residence if address is

current)

• Copy of passport

• Copy of Alien Registration card

Acceptable Proofs of Residency (Provide one document below)

• Copy of valid PA driver’s license or PA State ID with current address

• Copy of utility bills

• Copy of rent receipt or written statement from a non-relative landlord

• Copy of mortgage receipt

• Envelope of mail postmarked at least 3 months ago with applicant’s name and address

Acceptable Proofs of Income (provide one document for each type of income for your

monthly gross income)

• Copy of pay stubs, checks, and award letters from the last 30 days

• Employer’s written statement including employer’s name, address, and phone number and how

much was earned during the last 30 days

• Copy of Social Security award letter, current check, or direct deposit record in bank statement

• Copy of Worker’s Comp check, check stub or current award notice

• Copy of award statement for unemployment

• Copy of pension check or statement

• Copy of bank statement showing interest for bank accounts

• Copy of proof of income from educational loans or grants

• A written statement from a person or agency providing money or making payments for you.

• If you are self employed we need both, your estimated income and expenses for the last quarter

of the current year, typed in a company’s cover letter, signed and dated, and a copy of last year’s

federal tax return

• Copy of last year’s federal tax return

IN ADDITION TO THE ABOVE PROOFS,

WE NOW REQUIRE A COPY OF YOUR MOST RECENT

FEDERAL INCOME TAX (IE: 1040 - 1040EZ - 1040A, ETC.)

Palco Enrollment Form English Project Access Lancaster County Page 4