Income Verification Form
As a recipient of monies from the City of Manchester, we are required to ask for the following information of our clients. You must complete this form in order to complete your registration.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
In what country were you born?
*
How many people live in your household, including yourself?
*
Please Select
1
2
3
4
5
6
7
8
What is your annual household income? This figure should include everyone's income who you live with, added together.
*
I declare that all information provided above regarding household income is true and correct. I certify that I am a US citizen or qualified alien lawfully in the United States I understand that knowingly providing false or incomplete information is unlawful and can lead to prosecution for fraud.
*
Submit
Should be Empty: