Zero Income Application

Zero Income Form

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Enterprise Rancheria

2133 Monte Vista Ave.

Oroville, CA 95966

PHONE (530) 532-9214 FAX (530) 532-1768

One form must be completed by each unemployed household member who is eighteen years of age or older who is not employed regularly or has no source of income. Failure to complete this from properly will only delay your application process.

Zero Income Form

Applicant Name(Required)

1. Did the household receive any cash amount within the last 30 days?(Required)

2. If there is no income, what is your housing situation and how do you provide?(Required)

3. Do you pay your own utilities (water, electric, etc.)? Please explain how you are able to afford them and if you cannot afford them, how you provide in exchange to help out.(Required)

4. Do you have your own transportation? If so, how are the costs to operate your transportation met? Please explain.(Required)

5. Are there others that live with the household that are not included on the application and is their food prepared separately?(Required)

6. Explain how you provide for your basic personal needs such as personal hygiene, clothing, shoes, etc.(Required)

I have completed the above information to the best of my ability and verify that it is true.

Typed Signature(Required)

Signature Date(Required)

Zero Income Application

Zero Income Form

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