Full Time Air Conditioning
Resume:
Assistance Application
www.michigan.gov/mibridges Page 1 of 7
Date 04/12/23
Time 04:24 PM EST
T Number T35217292
Programs Requested
FAP
Introduction
Primary Applicant
Preferred Spoken Language
English
Preferred Written Language
English
What communication assistance do you need?
I don’t need assistance.
First Name
Anthony
Middle Name
Monychigok
Last Name
Makuach
Suffix
Sr
DOB
01/01/1982
SSN
***-**-****
Home Phone # Cell Phone #
*****************@*****.***
Do you need to be contacted at a hearing assistance number? No
Are you homeless and don't have a permanent place to stay? No
Home Address
1404 Wickham Dr
Home Address 2
City/ State/Zip
Lansing, Michigan, 48906
What county do you reside in?
Ingham
Is your mailing address different than the home address above? No
Expedited FAP Screening
My monthly income is less than $150 and I have $100 or less in cash/accounts right now My household’s combined monthly income and cash/accounts are less than my household’s combined monthly rent/mortgage and utilities
I am a migrant or seasonal farmworker whose income has stopped and I have $100 or less in cash/accounts right now Household Information
Assistance Application
www.michigan.gov/mibridges Page 2 of 7
Program Requests
Programs Requesting HCC FAP Cash CDC WIC SER
Anthony Makuach Sr
Household Members
Individual Details
No Does anyone in your household have a disability or a physical/mental/emotional health condition? Yes Is anyone in your household currently enrolled in college/vocational school? Who: Santino Makuach
1
First Name
Santino
Middle Name
Lual
Last Name
Makuach
Suffix
DOB
01/01/1981
Sex
Male
US National/Citizen
Yes
SSN
***-**-****
Ethnicity (Optional)
Race
Married
Yes
Lives In the Home ?
Yes
Relationship to Head of
Household
Step Brother
Eligible Immigration Status
2
First Name
Anthony
Middle Name
Monychigok
Last Name
Makuach
Suffix
Sr
Sex
Male
US National/Citizen
Yes
Ethnicity (Optional)
Race
Married
Yes
Eligible Immigration Status
Assistance Application
www.michigan.gov/mibridges Page 3 of 7
Yes Is anyone temporarily absent from the home (work, military, hospital, etc.)? Who: Anthony Makuach Sr
Yes Has anyone in your household ever served in the military or armed services? Who: Santino Makuach
No Is anyone living in a facility or special living arrangement (now or within the past 3 months)? No Is anyone in your household going to an alcohol or drug treatment program? No
Do you believe pursuing child support would be harmful for you or your child (examples: include threats of abuse, history of abuse, incest, rape.)? No Is anyone in your household a non-parent caregiver? No Is anyone in your household a foster parent?
No Is anyone in your household an adopted child?
No Is anyone in your household currently a migrant farmworker? No Is anyone in your household currently a seasonal farmworker? No Is anyone in your household currently a refugee/asylee? No Is anyone in your household currently a victim of domestic violence? No Is anyone in your household a victim of trafficking? Assets
Yes Does anyone in your household have money or accounts? Yes Does anyone in your household have property?
No Has anyone in your household sold, transferred, or given away assets in the last 90 days? Accounts
Account Holder Account Type Name of the Bank/Institution Amount Joint Account Anthony Makuach Sr Checking Cortrust Bank $50.00
Santino Makuach Checking Netspend $150.00
Property
Assistance Application
www.michigan.gov/mibridges Page 4 of 7
House(s) Buildings Rental Property Land/Lot
Burial Plot Other
Income
Yes Is anyone in your household employed now or in the last 30 days? No Is anyone in your household self-employed?
No Does anyone in your household have additional income? Yes Has anyone in your household had a change in employment in the last 30 days? Quit, Other
Please explain.
Anthony move from South Dakota where he just quit full time job to come and stay with Santino. But he is still unemployed in state of Michigan currently. He have the family and Santino just borrowed this new house and he he is supporting his 5 children. Anthony too have children overseas needing quick support. Employment
Household Member Employer Name Avg. Hours/Wk Wages/Tips (before Tax) Paycheck Frequency Santino Makuach
National Guard(US
ARMY)
40.00 $ 1,500.00 per 2 Weeks
Once Every 2
Weeks
Anthony Makuach Sr N/A 0.00 $ 0.00 per Hour Daily
Expenses
Yes Does anyone in your household pay for housing expenses? Yes Does anyone in your household pay for utilities (not included in rent)? Yes Does anyone in your household pay for dependent care expenses? Yes Does anyone in your household pay for medical expenses? No Does anyone in your household pay for court ordered expenses? Yes
If utilities are included in your rent, does anyone in your household pay an extra fee for air conditioning?
Housing
Who pays? Type of Expense Amount Frequency
Santino Makuach Mortgage $2,800.00 Month
Assistance Application
www.michigan.gov/mibridges Page 5 of 7
Utilities
Heat Electricity (Non-Heat) Trash Pickup Cooking Fuel Air Conditioning Water/Sewer Phone
Dependent Care
Who pays? Type of Expense Who is it for? Amount Frequency Santino Makuach
Childcare (day care, after
school programs)
Children $200.00 Month
Santino Makuach $0.00
Medical Expenses
Who pays? Type of Expense Who is it for? Amount Frequency Santino Makuach Health Insurance $ 100.00 Month
Santino Makuach Hospital Bills $ 200.00 Year
Santino Makuach Prescription $ 200.00 Year
Santino Makuach Transportation for Care $ 200.00 Year Program Details
FAP
No Does anyone buy and make food separately from the rest of the household? No Is anyone in your household a boarder?
No Does anyone in your household receive tribal food distribution benefits? No Does anyone who you do not share food with pay any portion of housing expenses or utilities? No
Has anyone applying for FAP received more than $20 in State Emergency Relief (SER) energy payments or Michigan Energy Assistance Program (MEAP) payments in the last 12 months? No
Has anyone applying for FAP received more than $20 in the Home Heating Credit (HHC) in the last 12 months?
Final Details
No Has anyone ever received assistance from Michigan in the past (or currently)? No
Has anyone ever been disqualified from public assistance due to welfare fraud or an intentional program violation in any state, including Michigan? No
Has anyone ever been convicted for receiving cash or food assistance from two or more states for the same time period?
No Has anyone received Food Assistance from another state in the last 30 days? Assistance Application
www.michigan.gov/mibridges Page 6 of 7
Wrap Up
No
If you are not registered to vote where you live now, would you like to apply to register to vote here today?
No Do you want someone else to act for you or represent you in this case? No
Do you want someone else to have a Bridge Card and access your Food Assistance benefits to shop for you?
Anything else?
Signature
By signing this application you are agreeing to the below: Your Responsibilities
I have told the truth; I understand that I can be held criminally responsible for lying on this application. I will have to provide papers that show what I’ve told the department is true. I will have to repay any benefits I should not have received, even if it is the department’s error. I will have to tell the department of any changes to the information I provided on my application. I agree to cooperate with state or federal reviewers for an audit. I agree to release my information for program needs. I will use my benefits legally and will not sell, trade, or give away my benefits online or in person. I have received, reviewed, and agree to the information provided in the Information Booklet. The Department’s Responsibilities
If you think we, the department, made a mistake, you can ask for a hearing. The Michigan Department of Health and Human Services will not exclude from participation in, deny benefits of, or discriminate against any individual or group because of race, sex, religion, age, national origin, color, height, weight, marital status, gender identification or expression, sexual orientation, partisan considerations, or a disability or genetic information that is unrelated to the person’s eligibility. Information Booklet
View Information Booklet
The application information booklet contains important information about the programs you are applying for and your rights, responsibilities, and privacy. You can view the information booklet at the link above and save or print it for your records.
Assistance Application
www.michigan.gov/mibridges Page 7 of 7
Sign Here
Under penalties of perjury, I state that I have reviewed this application, and to the best of my knowledge and belief, the answers I give within this application are true, including household, citizenship and non-citizenship information, and I have listed all amounts and sources of income and property I receive/own. If I am declaring an Authorized Representative, by signing below, I allow this person to sign my application and get official information about this application. For Healthcare only, I authorize my Authorized Representative to act for me on all future matters. If I am signing as an Authorized Representative for Healthcare, I attest to my agreement to meet confidentiality and act in the best interest of the beneficiary. Signature of Applicant
Anthony Makuach
Contact this candidate