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:03oiI? 6? - 
I I . "I?Inpp. 0535

WELFARE APPLICA. 3W 9

Loimd
!

P.

^

I

Bj.rcJidBy

Naiae

8.5.-

<Lc\9^s-v
v-v-^
■
<,.-}
Spouse or Rootn Mates Herae Birthday ^

D

.

?OOaWO

Address
Haiaes

Of

Xn

Household

S.S. Rumber

<Pc

City
Persons

State

S.S.

Birthday

Number Employed,

Rent

Wages

$

O a s

Welfare

S

S

Number

Subsidized?

Electricity
W a t e r

5.S.Z.

Te l e p h o n e

S

Food

Unemployneht $
$

O t h e r
TOTAL

?

v

^

'5

Food Stamps 5

TO TA L

Zip

E X P E N S E I N F O R M AT I O N

I N C O M E I N F O R M AT I O N

other

NuinBei:

S
$

$
?
$
S

What >:ind of help are you needing? Y"ooc)^
r opcK. .
Would you like prayer for some need in your life?
Are you interested in Sunday School for you or
your children?
Do you want to be referred to a church for any

Yes ^No^

follow-up contact?

I give The Salvation Army permission to call my employer, welfare
c a s e w o r k e r a n d o t h e r s o c i a l s e r v i c e a g e n c i e s f o r v e r i fi c a t i o . i
purposes, advocacy and referrals.
PLEASE

SIGN

t

11/9

App. 005859

 9

9

^ar.e : lo/20/9'i Social services Master File case History Pago l
i

Case

mber

Last

Name

Maiden

First

il47aBUEke——•

Name

Name

Date

Birth

*"Fr.ed.,>

-

Of

Ode

Gex

10/00/63..

Mar

Eth

Ode
H

See.

1

social

No.

450-28-1063
QOO-OO-OOOO

Drivers
License
Service
Service
St
NUTiiber
Entry
Dt
Dischg
Dt

Church
Pref.

•First Asst: 06/08/92 Last update
Last

Address;
Po
«Bn!j»»jr6"f=:Pobert

Box
0

Income

Asst!

06/08/92
343

Applicant

10/20/94

Pocono
0

^

Pines

—-

PA

18350

Spouse

.

0^

Other

S o u r c e

0

Stamps

0

Skills
Last Emp

Monthly Rept, .

M
onthly i/tilltie«
Unusual Expenses
—Assistance

seq

0

Type

FQ

Date

06/08/92

0
0
0

Vouch
Status

Detail

Vendor

Redeemed

1213S

R

0

Date
Cde

N

Chk

—

vendor

Salvation

Amy

Nome

Corps

value

$10.00

End of Report

-RECJWmW rod AXEflta-S UMf

G E R A L D L . G AT L I N
SCSOCANT

U S. ARMrOeCRUITER

U. S. ARMY NAMPA RECRUITING STATION
I >1« CmrOWELL HUVO
N C I i I PA . l O a S f S I

—

OFriCC PMONC I20B)

11 bO

App. 005860