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Last Name Claimant s First Name Spouse s First Name Address State PA City Municipality circle one Zip Code 180 Glendon Borough West Easton Borough Phone Number -- Wilson Borough Williams Township I certify that as of December 31 2016 I was check only one box Claimant age 65 or older Claimant under age 65 with a spouse age 65 or older who resided in the same household Widow or widower age 50 to 64 Permanently disabled and ages 18 to 64 A. TOTAL INCOME received by you and your spouse during...

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8. Step 8: Keep a copy of the filled-out form for your records.
9. Step 9: Submit the completed form through the designated method as outlined in the instructions.

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What is this form must be?

This form is a required document for reporting financial information.

Who is required to file this form must be?

Any individual or organization that meets the specific criteria set by the governing body.

How to fill out this form must be?

You must accurately fill out all relevant sections with the required financial information.

What is the purpose of this form must be?

The purpose of this form is to provide transparency and accountability in financial reporting.

What information must be reported on this form must be?

Information about income, expenses, assets, and liabilities must be reported on this form.