Include income from all sources, including gross wages, tips, social security, disability, pensions, annuities, veteran’s payments, net business or self-employment, alimony, military, child support, unemployment, and public aid.
Number of Persons Living in Your Household: *
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Number of Dependent Children Under the Age of 18: *
Your answer
By submitting this form you certify that the family size and income information shown above is correct. Copies of tax returns, pay stubs, and other information verifying income may be required before a discount is approved.
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