Property: the Hitchner Management Agent

Household Member

Source

Amount

per

per

Regular gifts or payments from anyone outside of your household?



Yes



No

Household Member

Source

Amount

per

per

Regular payments from lottery winnings or inheritances?



Yes



No

Household Member

Source

Amount

per

per

Regular payments from rental property or other types of real estate transactions?



Yes



No

Household Member

Source

Amount

per

per

Any other income sources or types not listed?



Yes



No

Household Member

Source

Amount

per

per

Do you or any other household members expect any changes to your income in the next 12 months?



Yes



No

Household Member

Source/Increase/Decrease

Amount

per

per

Are you or any other ADULT household members claiming zero income?



Yes



No

Household Member:

Explanation: