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Verification Documents Required for e-Form #
R50109490
In order to finish processing this case, please obtain copies of the documents below:
Note: If information is missing or you have any questions please contact HELPLINE at 1-800-692-7462
Department of Public Welfare
Provide Proof of
Individual
Provide copy of one of the following
Individual
Disability
AHMAD A SANCHEZ Jr.
Medical information to verify disability and/or need for
medication
Provide Proof of
Individual
Provide copy of one of the following
Income
Other Income - SSI
AHMAD A SANCHEZ Jr.
Bank statements, 1099 form, Benefit Payment Check,
SSI Award Letter, Award Letter, Income Tax Record,
Departmental Identification Card
Provide Proof of
Individual
Provide copy of one of the following
Expense
Expenses - Telephone
AISHA SANCHEZ-WILLIA
Bill, Current statement, Receipt from the telephone
company
Expenses - Electric
AISHA SANCHEZ-WILLIA
Bill, Current statements, or Receipts from the utility
company, A statement from the landlord when costs are
shared, Receipts from utility company or landlord, A
statement from the landlord when costs are shared or a
lease showing the house is responsible for heating
and/or cooling costs separate from rent
Expenses - Gas
AISHA SANCHEZ-WILLIA
Bill, Receipts from utility company or landlord, Current
statement
Provide Proof of
Individual
Provide copy of one of the following
Resource
Resources - Cash or Financial
Holdings - Savings Certificate
AHMAD A SANCHEZ Jr.
Bank Records, Sales Agreement, Articles of Agreement,
Notes, Financial Institution Statements, Insurance
Appraisal, Bond Certificates, Securities, Check for Lump
Sum Payment, Will, Stock Certificates, Real Estate Tax
Receipt, Life Estate Agreement, Life Insurance Policy,
Income Tax Record
Delaware County Crosby District
701 Crosby Street
Suite A
Chester, PA 19013-6099
Info
Number:
610-447-3015
Fax
Number:
610-447-5399
Email:
[email protected]
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