USTED MANDAR POR CORREO LOS SIGUIENTES DOCUMENTOS:
Por favor NO USE CORRECTOR en su aplicación.
Si tiene cualquier pregunta por favor no dude en hablarnos al (209)723-3201
You are being asked to complete this form because you requested assistance, and state that your entire household cannot provide proof of income. The State of California requires the applicant to report all sources of income. This form will help us understand how you are meeting expenses. Please complete the information below:
By signing this form, I affirm that I believe these facts are accurate and true. I give the Service Provider my permission to verify this information.
I may be held liable under federal or state law for knowingly making false or fraudulent statements
Merced County Community Action Agency Energy/Weatherization Department 1235 W. Main St. – P.O. Box 2085 – Merced, CA
I certify that this statement is true and correct to the best of my knowledge, and authorize the release of any and all information necessary for verification purposes.
Yo cerifico que esta declaracion es cierta y correcta, y autorizo el uso de esta informacion para proposito de verificasion.