Document Upload Form

Document Upload Form
Please use the form below to upload images of your documentation.

Allowed file types are: pdf, doc, docx, zip, jpg, jpeg, png, gif
Name *

First Name Last Name
Phone Number
County *

Darke Greene Montgomery Preble
Drivers License or State ID

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Cancel of
Social Security Cards for all household members

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Cancel of
Birth Certificates for all household members

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Cancel of
Last 30 days of income

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Check stubs with gross amounts from wages, SSI, SSDI, TANF, Child Support, 1099 for self-employment, odd jobs, etc. Cancel of
Leasing agreement (most current)

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Cancel of
Letter of support from anyone who has provided financial support (family, friend, church, etc.)

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Cancel of
Proof of hardship

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Loss of job, hospitalization, leave from employer, eviction, disconnect notice, etc. Cancel of
Proof of pledge from other agencies (if applicable)

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Cancel of
Food Stamp print out (if applicable)

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Cancel of
Medical documentation (Medicaid)

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Cancel of
Any documentation pertinent to hardship

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Discharge paperwork from hospital, copy of bills, receipt of payment, etc Cancel of
Bank Statements (1 months)

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Cancel of
Rent Ledger (Get copy from landlord)

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Cancel of
Letter of separation from employer

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If no longer employed/ letter must be from employer and state start date and last date worked Cancel of
Signature

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