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Household Characteristics <br />How many members are in your household? How many are dependents? <br />Please indicate the number of people in your household that are aged: <br />Under 18 18-25 26-35 36-45 46-55 56-65 66 or older <br />How many wage-earners are in your household? <br />What do you expect your total annual household income to be at the end of this calendar year �2006)? <br />Please circle the income range on the same line as your household size: �oss ��o� may ve ��r�uiared va�ed on <br />adjusted gross reported under IR.� Form 1�� frrr federal income tax purposes. <br />Household Income Ranqe <br />Less than Between Between Between More than <br />i $.��r� ���.�i-��'.,�� ��1.7�1-���,95� $5�,��C-$�a�,��� $55,9�1 <br />2 $��,��� $ 3 7, ��1-$���,70� ,��?, �1-���,500 �6�,$� E -$��, 3�a� � ��.3 �iI <br />� .���,�z� ���_��i-���,��� ���,���-���.��� ��a,��:-�e�,�e� ���.��� <br />� ���,i� ���,t�����.��o ��,��t-��s,�aa ���,��-��.�� ��.��� <br />5 ��.��� ���,��t-���,�� ���,���-���,�s� ���.��� �ia�,��� �i��.��� <br />I certify that the information presented on this form is complete and accurate to the best of my <br />knowledge. <br />Name <br />Unit No <br />Address <br />Date <br />e <br />