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Home
County Offices
County Judge
Commissioners Court
County Attorney
County Clerk
County Treasurer
County Tax Assessor
Constables
Sheriff
Justice of the Peace
County Auditor
Human Resources
Planning
Other County Offices
District Court
District Judges
District Clerk
District Attorney
Resources
Financial Transparency
Check Registers
Audits
Monthly Financial Reports
Budgets
Annual General Ledger
Truth In Taxation
Road & Bridge Department
Employment Opportunities
Collections
Employee Forms
Foreclosure Postings
Remote Desktop
Unclaimed Funds
Passport Department
Public Information Officer
Make a Payment – Property Tax
Make A Payment – Motor Vehicle
News
Events
Current Bids & Proposals
Individual Financial Assistance Request Application
APPLICANTS QUALIFY ONLY IF THEIR ANNUAL GROSS INCOME IS:
Single Filed: < $75,000
Head of Household: < $112,500
Married Filed Joint: < $150,000
Financial Assistance Request Application - County of Maverick
Name of Applicant
*
Name of Applicant
First
First
Last
Last
Date of Birth
*
Last 4 of SS#
*
Address
*
Address
Address
Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
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Country
Phone
*
Secondary Phone
*
Number of Adults Over 65 In Home:
*
Number of Adults In Home:
*
Number of Children In Home:
*
Claimant #1
*
Date of Birth:
*
Last 4 of SS#
*
Claimant #2
Date of Birth:
Last 4 of SS#
Claimant #3
Date of Birth:
Last 4 of SS#
Claimant #4
Date of Birth:
Last 4 of SS#
Claimant #5
Date of Birth:
Last 4 of SS#
Claimant #6
Date of Birth:
Last 4 of SS#
Did you receive any compensation from assistance programs? If so, please list date, program, and amount received: (Federal Grant, Stimulus, Loan, SNAP, TANF, etc.)
*
Reason for request: (How has COVID-19 affected you or your family, financially?)
*
Financial Needs: (How would this financial assistance address your needs?)
*
Proof of Income (Income Tax Return Statement or Income Tax Transcript)
*
Drop a file here or click to upload
Choose File
Maximum upload size: 33.55MB
Identification
*
Drop a file here or click to upload
Choose File
Maximum upload size: 33.55MB
Proof of Residence
*
Drop a file here or click to upload
Choose File
Maximum upload size: 33.55MB
Signature
*
Clear
I am over the age of 18 years and I have personal knowledge of the facts contained herein, and they are true and correct. If it is later found that the information that I have provided is not correct I understand that I may be required to repay any and all benefits that I received or were paid on my behalf.
If you are human, leave this field blank.
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