Application Form (2905-EG) - Nevada Division of Welfare ...
Application Form (2905-EG) - Nevada Division of Welfare ...
Application Form (2905-EG) - Nevada Division of Welfare ...
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YES<br />
Houses/Land or<br />
Buildings<br />
MISCELLANEOUS<br />
Is this property currently<br />
for sale? Yes No<br />
TYPE OF RESOURCE OWNER(S) CURRENT VALUE<br />
Promissory Notes<br />
Cash on Hand<br />
Other: (please list)<br />
31. Are any <strong>of</strong> the resources in question 30 designated as money for burial? YES NO<br />
If “YES,” Which Resources?<br />
VEHICLES CARS<br />
32. Do you or any person(s) in your household own, or are they buying, a car, motorcycle, trailer, truck, camper, boat, motorhome,<br />
ATV, etc.? (Please include any vehicles that are not currently working.) YES NO<br />
If “YES,” Please complete the information below:<br />
OWNER<br />
TYPE OF<br />
VEHICLE<br />
YEAR, MAKE &<br />
MODEL<br />
IS THE VEHICLE FAIR MARKET<br />
R<strong>EG</strong>ISTERED VALUE<br />
YES NO $ $<br />
YES NO $ $<br />
YES NO $ $<br />
$<br />
AMOUNT<br />
OWED<br />
TRANSFERRED RESOURCE TRAN<br />
33. Have you or any person(s) in your household sold, traded or given away money, vehicles, property or other resources,<br />
closed any bank accounts or purchased any annuities in the last 60 months? YES NO<br />
If “YES,” Who? What resource was transferred?<br />
When? / MM/YYYY What was the value <strong>of</strong> this resource when it was transferred? $<br />
Who was the resource transferred to? Relationship to you:<br />
Why was the resource transferred?<br />
For Official Use Resources:<br />
6
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