Loading...
HomeMy WebLinkAboutMINUTES - 10121993 - H.3C FROM: Perfecto Villarreal, Director Social Service Department DATE: October 12, 1993 SUBJECT: APPEAL OF GENERAL ASSISTANCE EVIDENTIARY HEARING DECISION BY LARRY PRICE SPECIFIC REQUEST(S) OR RECOMMENDATIONS AND BACKGROUND AND JUSTIFICATION RECOMMENDATION: That the Board deny Larry Price's appeal of the General Assistance Hearing decision. BACKGROUND: Claimant filed request for Hearing on August 13, 1993. The Hearing was scheduled for September 7, 1993. The claimant did not appear for the hearing, and the claim was dismissed. Signature: Z, U = - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ACTION OF BOARD ON October 12 , 1993 APPROVED AS RECOMMENDED x OTHER This is the time heretofore noticed by the Clerk of the Board .for hearing on the appeal from the General Assistance Evidentiary Hearing Decision by Larry Price. Jewel Mansapit, General Assistance Program Analyst, Social Service Department, presented the staff report on the appeal . Larry Price, the appellant, did not appear to testify. IT IS BY THE BOARD ORDERED that the above-recommendation is APPROVED; and the appeal of the General Assistance Evidentiary Hearing Decision by Larry Price is DENIED. VOTE OF SUPERVISORS: _ x UNANIMOUS (ABSENT IV ) AYES: NOES: ABSENT: ABSTAIN: I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN AD ENTERED ON THE MINUTES OF THE BOARD OF cc: Social Service Department SUPERVISORS ON THE DATE SHOWN. Program Analyst Appeals Unit County Counsel ATTESTED October 12 , 1993 County Administrator PHIL BATCHELOR, CLERK OF THE BOARD OF Larry Price SUPERV OR AND C UNTY ADMINISTRATOR BY 1-4 , DEPUTY CLERK OF THE BOARD Inter-Office Memo TO: Social Services Department DATE: October 1, 1993 Appeals and Complaints Division and Program Analyst FROM: Jeanne Maglio, Chief Clerk Ann Cervelli, Deputy Clerk W SUBJECT:Hearing on Appeal from Administrative Decision Rendered on General Assistance Benefits Filed By Larry Price -------------------------------------------------=-------- ---------------------------------------------------------- Please furnish us with a board order with your recommendations and a copy of all material filed by both the appellant and the Social Service Department at the time of the Appeals and Complaints Division evidentiary hearing, plus any information which your department may wish to file for the Board appeal which is set for 2 : 15 p.m. on Tuesday, October 12, 1993 . Attachment CC : Board members County Administrator County Counsel Phil Batchelor The 'Board of Super rs Contra Clerk of the Board and County Administration BuildingCotCounty Administrator Costa 651 Pine St., Room 106 J (510)s46-2371 • Martinez, California 94553 County Tom Powers,1st District Jeff Smith,2nd District se c Gayle Bishop,3rd District Sunne Wright McPeak 4th District '^ Tom Toriakson,5th District `' '• .y rT'9 ('OUt7'� October 1, 1993 Mr. Larry Price 261 Spinnaker Way Pittsburg, CA 94565 Appeal to Board of Supervisors General Assistance Benefits In response to your request and pursuant to Section 14-4 . 006 of the County Ordinance Code, this is to advise that a hearing on your appeal from the administrative decision rendered in your case on General Assistance benefits will be held before the Board of Supervisors in the Board Chambers, Room 107, County Administration Building, 651 Pine Street, Martinez, California at 2 : 15 p.m. on Tuesday, October 12, 1993 . In accordance with Board of Supervisor Resolution No. 92/554, your written presentation and all relevant material pertaining to the appeal must be filed with the Clerk of the Board (Room 106, County Administration Building, 651 Pine Street, Martinez) at least one week before the date of the hearing. Your attention also is directed to the other provisions of said Resolution (copy enclosed) which set forth the General Assistance Appeal procedure. Very truly yours, PHIL BATCHELOR, Clerk of the Board of Supervisors and County Admi . stra r By W (VI .—OLO n Cervelli, Deputy Clerk Enclosure CC : Board Members Social Service Department Attn: Appeals and Complaints Program Analyst County Counsel County Administrator �• THE BOARD OF SUPERVISORS OF CONTRA COSTA COUN-N,CALIFORNIA Adopted this.Order on August 4, 1992 by the following vote: AYES: Supervisors Fanden, Schroder, Torlakson, Weak NOES: None ABSENT: Supervisor Powers ABSTAIN: None ssessssssssssssssssssssessssssssssssssssssssssss===== SUBJECT: General Assistance Hearing } Resolution Number 92/.554_ and Appeal Procedures } The Contra Costa County Board of Supervisors RESOLVES that the provisions of Resolutions No. 74/365,75/28, 87/468, and 88/576 which established standards for General Assistance Hearings and Appeals are hereby superseded effective September 1, 1992: Part 1 Hearings 101. General Assistance applicants shall be given written notice of action to deny an application. 102. General Assistance recipients shall be given written notice, mailed at least 10 days prior to the effective date, of proposed action which will reduce, suspend or terminate his or her General Assistance grant for cause. Prior notice is not required for action resulting from Board of Supervisors' changes in grant levels. 103. A General Assistance applicant or recipient shall receive a Social Service Department bearing upon their timely written request. (a) The applicant or recipient must deliver or mai] a written request for a bearing within fourteen days of the date the Notice of Action was mailed. Absent evidence to the contrary, the notice is Presumed to have been mailed on the date it bears, and a request for a bearing is presumed to Have been delivered on the date it is received and mailed on the date it is postmarked. 104. Where a GA recipient timely requests a bearing challenging a proposed action which will reduce, suspend or terminate his or her General Assistance grant,the proposed action will be stayed until a decision is rendered. (A) Actions implementing Board of Supervisor changes in grant levels are not appealable, and bearing requests based thereon may be summarily denied. 105. Hearings will be scheduled within thirty days of the date of receipt of a request for a bearing. The Appeals Unit will mail a written notice of the bearing to the claimant at least ten days in advance of the Hearing date. 106. When a request for a bearing has been received,the claim may be reviewed and resolved in the claimant's favor by a pre-bearing review. (a) Proposed pre-bearing resolutions shall be reviewed and approved by the Appeals Manager and the General Assistance Policy Manager. 107. If the claimant is unable to attend the bearing at the originally sebeduled date and time, and a timely request for postponement is made,the Hearing Officer will make an evaluation of the request.The bearing will not be continued beyond the bearing date unless authorized by a Hearing Officer on one of the following grounds,which require verification: (a) bearing is continued at request of the Social Service Department, i (b) mandatory court appearance which cannot be accommodated by adjusting the bearing time, 4 (c) illness which prevents travel, (d) death in the immediate family, (e) other substantial and compelling reason. (as approved by the Appeals Manager) 108. Decision (a) A written decision shall be mailed to the claimant within thirty days after the bearing record is closed, unless the Department extends the time in writing,for cause. (b) Proposed decisions shall be reviewed and approved by the Appeals Manager and the General Assistance Policy Manager prior to notification of the claimant.The Hearing Officer's findings of fact are not subject to change, but the General Assistance Policy Manager may order re- bearing for cause. Part 2 Appeals to the Board 201. The applicant or recipient may appeal an adverse bearing decision to the Board of Supervisors. 202. A written appeal must be received by the Qerk of the Board of Supervisors aithin fourteen days after the decision has been mailed to the claimant. Absent evidence showing the contrary, a bearing decision is presumed to have been mailed on the date it bears. (a) An appeal to the Board will not stay the implementation of the Hearing decision, and the recipient shall not be entitled to continue to receive assistance pending further bearing. (b) The appeal will be scheduled for the first available Board meeting,but no earlier than the third meeting following receipt of the appeal. 203. The Administrative Review Panel may review appeals of Hearing decisions and recommend proposed action to the Director. ti (a) If the Director supports the bearing decision,the Appeals unit will be notified to proceed with the presentation to the Board. (b) U the Director finds in favor of the claimant, the Qerk of the Board will be notified to withdraw the item from the Board agenda.The appropriate Social Service District office will be advised to take corrective action. 204. Both the appellant and the Department must file all written materials at least one week before the date set for the Board hearing.New material must be served by mail on the opposing party. 205. (a) Upon bearing the appeal,the Board shall make-any required fact determinations based on the record on appeal and testimony received by the Board.This record shall include the Department's Hearing Officer's fact findings,plus any papers filed with that Officer. (b) If the facts upon which the appeal is based are not in dispute or if any disputed facts are not relevant to the issue ultimately to be decided by the Board, the Board will proceed immediately to the next step without considering fact questions.The parties may stipulate to an agreed set of facts. RESOLL7nOX NUMBER 92/5+ 206 ' (a) Once the facts are determined, or if there are no fact determinations required by the appeal, • the Board will consider legal issues presented by the appeal.Legal issues are to be framed, insofar as possible, before the Hearing and shall be based on the Department's Hearing Officer's decision and such other papers as may be filed. (b) Appealing parties may make legal arguments both by written brief and orally before the Board. U the issues are susceptible of immediate resolution,the board may immediately decide them at the appeal bearing. If the County Counsel's advice is needed on legal questions, the Board may take the matter under submission,reserving its final judgment until it receives such advice. 207. The Board may decide an appeal immediately after bearing or take the appeal under Awbmission. f 11r.er eMM1r tl+�+�r•�u9 ttae mn.et eevy� . lotion fait,, end W+W VM IOWA 9 d 11119 bow of 2, wTTE6 MILSvTULO C�OZuntf' two► RESOLUTION NUMBER 92/ 554 SOCIAL SERVICE DEPARTMENT CONTRA COSTA COUNTY TO: Ann, Clerk of the Board Date: September 27, 1993 FROM: Kate Quisenberry, Appeals Officer SUBJ: Larry Price Mr. Price is appealing the 9/8/93 Evidentiary Dismissal Decision based on his failure to appear for Evidentiary Hearing 9/7. He used a Food Stamp Notice of Action but it is clear he wants the Decision overturned. Please consider the attached as a request for Board appeal. Thanks. KQ:gs attachment Gen 9c (New 3/86) Please reply to: Social Service Department Contra 40 Douglas Drive Perfecto Villarreal Costa Martinez,California 94553-:068 s Director J County V "s OS�:,•`•GP 'a COlhr EVIDENTIARY HEARING DECISION: NOTICE OF DISMISSAL IN THE MATTER OF: County Number: 493634 C4FA Date of Notice: 3/04/93 LARRY PRICE Date of Action: 261 Spinnaker Way Filing Date: 8/13/93 Hearing Date: 9/07/93 Pittsburg, CA 94565 Aid Paid Pending? Y STATEMENT OF FACTS An Evidentiary Hearing was scheduled for 9/07/93. Claimant was duly notified of the date, time and place of Hearing via letter on 8/25/93. Claimant failed to appear for the Evidentiary Hearing; no postponement was requested. REASONS FOR THE DECISION Department Manual Section 22-300, V, A, 3 states that if a claimant fails to appear for an Evidentiary Hearing without previously arranging for a postponement, the claim may be dismissed. The originally proposed action shall take place immediately upon dismissal. ORDER The claim is dismissed as claimant failed to appear for the Evidentiary Hearing. The benefits shall be discontinued as proposed in the Notice. If you are dissatisfied with the order of this Decision, you may appeal the matter directly to the Contra Costa County Board of Supervisors. Appeals must be filed in writing with the Clerk of the Board, 651 Pine Street, Martinez, 94553 . You must submit your appeal within 14 days of the date of this decision. AID PAID PENDING A DECISION BY THE BOARD OF OF SUPERVISORS IS NOT AVAILABLE. Date: 9/08/93 Kate Quisenberry. Social Service Appeals Officer KQ/nf YOUR HEARING RIGHTS / To Ask For a State Hearing HOW TO ASK FOR A STATE HEART The best way to ask for a hearing is to fill out this pa\s1e.� The right side of this sheet tells how. it to: • You only have 90 days to ask for a hearing. Office of Appeals Coordinator Douglas Drive • The 90 days started the day after we mailed this notice. 40 Dou g • You have a much shorter time to ask for a Bearing if you want to keep Martinez,CA 94553.4068 "' ~ "•� You may also call 1-800-952-5253. v tng HEARING REQUEST m 1 wants hearing be &ause of an action by the Welfare Department Tof -CdfyY� ((�- County about my: ie end of EFCash Aid &I-rood Stamps ❑ Medi-Cal ❑ Other(list) - `T i-1 vo o'T p�rwC1ST' � M forr e - ., • M i lwj.� S�crr /�S Pr '�qP� Sc3 r.,i1 Ar -5253-. -834 ! Av � ACI,tJ� ;. Sit . X . CA ©CIO t(R.. co cor. ' ;I wil brrg.the per.00 to the hearing-to help me f, (narne and address•d:known rt t+K. 4 Ab J. a -0 -T tLOkS6 r6s-cw' C',9 ild fit ►rt 1 need an interpreter at no cost Lia I Lam. 1 4' D r' f n y 4,1 'd to me.My language or dialect is: [ ! My name: © _ an Address: Cti4J b1F: ( _ + et ur ��_ f � id Phone: 75 My signature �) y , p A � Date: `'•1 . KOMIA NOTICE OF ACTION �\ COUNTY OF -- :,-. .�_ H��T�DVW8 AGENCY c l 'i T R.y C O.J r M DEPARTMENT O:SOCIAL SERVICES C. ►�. ::=fi k.L Warkw m,bw :C4F' TaMpho- . _ : 70b 4771.,,,�. -. .•'._-.,..,. .,1-?. � . . :.154 DEi TA IR. BLVD4 :. N��D-`kA -�� 94509 =Wo*er. • - !i_aee.te.nn•u.e.ee>t6e �.''iae.at � .«I uas.�s.r(.) •. _ �oOREss ,. =t;peani ut. lea- nli.,��ae,Ip�d Sa. a. e�.eke►f.�I.ob -c-, - _ y i- ' •tom , LARRY PRICE , �� , Y: : { ` \ . c �. ,' Statd,Hearing: ou-tt*kthis action is ivl`6 ,�iou r.• 261 SPINNAKER tiiY y P I TTS£U:�G L A 945 b5 ��• {`=1�.' • ca ,ask fS+r�et �9.-T beck of this1p ie WIS hpw` .. , Fie mss= Y benefits may not b� cfiangeE!'if you ask fof ;t1e m9 b$or this ac I%Clp 5' �3�`�� • Z all NZ '•YGOR FOOD STAMIPS'�SENEFITS qRF HANGED Ar .,45,90-130Yx ,F +SE• (2 ) THE NUMBER OF PEOPLE , �fHOUSf~HB ._Sitll7__DOWN R O.UR Lijj&EV c LID 2 #j gE + :Y�.' s 4 r...'`1�•.F, 4 Z..-_4. 4.) A COMBINATION OF REASONS .`(:1)st23 �J1 �K��1• `� �, * Qj 13 A�' Sw'.3 t #-PEOPLED©N YOUR MOUSEHOLI LYE G>E4i Ed AID-W- i PE SES" E �� �. T. f: .�- }-,�s.}T';. d.. t- 1 )I�dFDOD-"S'TARP'�BENEFITS h '[0#IEQ�L r OOD' STAHP t3W5ET StiMF1ARYfO09 tt J9 Ot,ftw RQ'8 .EARNINGS .L_: ; / #f [SLY. fOQO DTOt ON t It 441 OWP'67NUMBi`R OF PARSONS LAX :ALLaMABLE GROSS INCOME 738DJUSTED "OSS _f_A"fi&LjANCOMECL :0 .00 ;' PLUS-�-OTHER INCOME300r.D0' •' ;. L£$S-STA .NDARD. )F_OUCTIONl�i7 , 0 DJUg T.Eb INCOME' , t,,,,'�:<yi c: mpne hlon �!` ET 'MONTHLINCbh4E 3. . -. i t.,y•._ ......X.i- _ '' ! --.ice��'� `���� •j`�l�f'+i� ;.� �1��i�. � — i t, T:-I3 ACTION - IS REOUIREO BY THE FJLLUWI)iv LAWS -AhaijR• itEGULA-TIONS FGGO STA.1? MANUAL SECTION -63-503 F-LIGI61LI TY AND 8tN�1FI7. LE.VEL S- d3-50-y.3; 63-504.4 +1- .�R i2 D Appeals Unit Social Servicb'Department ur 77.4 _C;1c:+St= 1: _iE,+cFITS — I,�•Cu'F��6u:� mi LD CHANGE 90N(5/87) Cams ComaCoo"r ROUTE SlkP oswoar. TO:qa �jj PCN: DAIqM PIease Correct Addie C) A. 30 Muir Road,Martinez p z. 40 Douglas Dr.,Martinez C) T. 1340 ArnoldDrive#220,Martinez (3 Administration (TraininyAppeak) p M. 2500 Alhambra Ave-,Martinez O Area Agency on Aging p C. 4545 Delta fair,Antioch O C1 w. 3431 Macdonald Ave.,Rich. p L. 100 Glacier Dr.,Martinez loon's Gate) p H. 1305 Macdonald Ave.,Richmond p x. 2301 Stanwell Dr.,Concord p G. 304S Research Or.,Richmond KentralUed Closed Files) p E. 3630 San Pablo Gam Rd.,EI Sob. O v. 2450 A Stanwell j.ll DrC.,CCo�ncor( p R. 525 Second Street,Rodeo ( l1 n Fu C) F. 330.2Sth Street Richmond(PIQ i l OTHER DEPARTMENTS f MARTINEZ O Auditor iConuoller O DA Family Support f "O County Administrator O Welfare Section C) QA lnvestigationt O Risk Management O HeaIM Services O Data Processing Serviu O County Counsel O County Hospital O Probation O Alternate Defender O Ward O PwIchsning O County Personnel O CCC Health Plan O Q CONCORD WALNUT CREEK RICHMOND JUVENILE COUR1 E)Central Services O Office of Rewnue Collection Q Public Defender .(3 Antioch Q Public Defender p (] Q Richmond O O Martinet ❑OTHER: I AS ❑ Requested 13❑ NecessaryAction NOTE i ❑ Return i; ❑ Discussed ❑ information ❑ Discard i' Recommend ❑ rile A►p�pr�o+r iCAPPPature COMMENTS ' SEP 2 7 Ic913 Ii �l r FROM: , N. TELEPHONE NUMEER APPEALS 3-1790 R 2(Rev.02) n try NrssnrNrtr rna -MUMMA$r»arusMrc SOCIAL SERVICE DEPARTMENT CONTRA COSTA COUNTY TO: Ann, Clerk of the Board Date: September 27, 1993 FROM: Kate Quisenberry, Appeals Officer SUBJ: Larry Price Mr. Price is appealing the 9/8/93 Evidentiary Dismissal Decision based on his failure to appear for Evidentiary Hearing 9/7. He used a Food Stamp Notice of Action but it is clear he wants the Decision overturned. Please consider the attached as a request for Board appeal. Thanks. KQ:gs attachment Gen 9c (New 3/86) Social Service Department Please reply to: Department Conga 40 Douglas Drive Perfecto Villarreal Costa Martinez,California 94553-4068 s Director J County `s }ra coiiNi` EVIDENTIARY HEARING DECISION: NOTICE OF DISMISSAL IN THE MATTER OF: County Number: 493634 C4FA Date of Notice: 3/04/93 LARRY PRICE Date of Action: 261 Spinnaker Way Filing Date: 8/13/93 Hearing Date: 9/07/93 Pittsburg, CA 94565 Aid Paid Pending? Y STATEMENT OF FACTS l An Evidentiary Hearing was scheduled for 9/07/93. Claimant was duly notified of the date, time and place of Hearing via letter on 8/25/93 . Claimant failed to appear for the Evidentiary Hearing; no postponement was requested. REASONS FOR THE DECISION Department Manual Section 22-300, V, A, 3 states that if a claimant fails to appear for an Evidentiary Hearing without previously arranging for a postponement, the claim may be dismissed. The originally proposed action shall take place immediately upon dismissal. ORDER The claim is dismissed as claimant failed to appear for the Evidentiary Hearing. The benefits shall be discontinued as proposed in the Notice. If you are dissatisfied with the order of this Decision, you may appeal the matter directly to the Contra Costa County Board of Supervisors. Appeals must be filed in writing with the Clerk of the Board, 651 Pine Street, Martinez, 94553 . You must submit your appeal within 14 days of the date of this decision. AID PAID PENDING A DECISION BY THE BOARD OF OF SUPERVISORS IS NOT AVAILABLE. Date: 9/08/93 Kate Quisenberry Social Service Appeals Officer KQ/nf r -YyOUR HEARING RIGHTS ` To Ask For a State Hearing HOW TO ASK FOR A STATE HEARS Y� The best way to ask for a hearing is to fill out this paw The right side of this sheet tells how. it to: ��•' 0 You only have 90 days to ask for a hearing. Office of Appeals Coordinator ® The go days started the day after we mailed this notice. 40 Douglas Drive s You have a much shorter time to ask for a hearing if you want to keep Martinez, CA 945534068 You may also call 1-800'952-5253. ing , v HEARING REQUEST m •I wants hearing bnuse of an action by the Welfare Department- of 66(Jr& .5gLi- County about my: ie end of Cash Aid Ellood Stamps ❑ Medi-Cal ❑ Other(list) any extra y cwt1y-- 0W : "7 L 0) . }� �l�r►�l� '�. Sr�`3't" /IS: Pc "�012� 5c�u t :. O § � ,5 s£a £s �F� r O'''nom "� a SLA ( y 3 ,a::i�,rt �J�13 & :iV i• k/'��! jr � ur, s Krl �° � v yUlQ1�f ► aG 1�rarf , Q #f) ', t Twig bring tfus person to the heacmg:to help me n (name and address.if..known} ild i + w J Ip. 9r ss )rt I need an interpfeter at no cost ►L Gl i5.�—"fn�/ c R 'd to me.My language or dialect is: fin ��t1 .5�ki� �")Lf;v'9 = f ! ( My name: an Address: etWON J �S ur id Phone: My signature — } -�sDate: � _ DEL-1/93 - COUNTY OF - `srn1E of cAUFORNIA HEALTH AND WELFARE AGENCY NOTICE OF ACTION1 TR.A C0SIii DEPARTMENT OF SOCIAL SERVICES Nofi,Date Jp—.l S'—'�.� � .. - _._. `;tF .a r case {- Name t''ti i,il.._� •, ��f's ti Number �2-0493•x34-jU—J worker V. . 1. - j` Name Number 4 F'p T«eware -- : 7OR4771 ,, ==1545 1�E�.TA AiR BLVt;. Y�IV i47 94509 . i ( ions? Ask your Worker. - - 'al iiecniteane treAigel6e�de`±ti re w LrtaOai,>�r(a) - µooitess� - �'' •�' s- ue Aniiei rise ltc..� ibL' ✓F��60 ,S,e.�aiea tit_e�.sIe yfc� "�"•. >..:LARRY PRICE � � �� - S, �•\ t" �,.�.� ,; 2 61. .SPINNAKER N Y Statd.Hearing. .,(F you think t is actron'is Gmgng, you ' P Y TTS"BJ t G C A 945 b5 +�,.• � !,' .r C2 ja*fgr.'al*aring T t .of this`ptage tells ! Y may Chang you ask for ' ` : o benefits not p' rf a, arin9 b$�or this actlpSt ,c :,�� �" YGt)R FOJD $TAMP S'*8ENEFITS qRE "iLHAJ1iGEDSE� ' r` ;T•. (2 )` THE NUMi3�R OF PEOPLE., YU.UR HOUSt7 _=lltt�t7DO1�N 4GUii._.�f.QAJSEHOLO' 3£j(i�f lt$E6 t1�ir�D dR , .; R, -44 ) A COMBINATION OF REASONS :(;I )sit"2 F i+c �i• " i`TF , wK� 8J-9='tK..AI' yi�:?L`3t �fC; `t4 { tOl4P.I} AI. >t'!I €SnLII 10 x s < . ,�YJ3:uR r�FiJO @a_S T AIdP,. lri t�` 1 =PEOPLE IN YOUR HOUSEHOLo ME CO t tea A �• s'�tlRaaFUo STAfP�BENEFITS H 11, DA a ups+ �p X. S 1' ,w p3 . �'�_ � ✓',,�. OOD' 5 TAMP dUtiGE SUMMARY tifOR 09J �•_.x' ` Y f:OOi� �01YIL+ t�RU S .EA RN I fG S ' _4 ki flitP'6NUMBR. OF_ Pra ARSONS +IAX. :ALLOMIABLE GROSS INCOME 738.t1(J �OJUsTED ,cROss --E�►RNEI�.,�If�COME, := t.�„� - PLUS"OTHER INC•OM>; .700* ' i:E$$-S.TANDARQ.:.:D>eDItCTL ON ,ti ,_ � �a. Q ,M, ►OJUST,Eb INCOME 3S1+i 0 JET `'M O N T HL t I N C b M Er' )tl�tt .7-4 Al!' a r l TlHl3- AC Tl0N .' IS RE"OUIRE0 5Y Ttit FJLLE)i�ill�ty LABS •AhU/0R-.REGULATIONS FOGS STA`ti' MANUAL SECTION b3-503 ELIGI61;LI TY AND 6LN>Ell, LE.NE IS' t)3-,50.�.3�. b3-5U4.4 • YDu Appeals Unit SOclal Servico Department .E .o I: iF e -FITS — I:�l '.f`'� •ii.iic nii` Li) CHANGE= 19ON(5/87)• a r _ COUNTY OF T^ STATE OF CALIFORNIA _ HEALTH AND WSLFAREGY NOTICE OF ACTION F� l L}:'vTit,i 1 L1! + C t 1\If DEPARTMENT OFFSOCIALSERVICES Notics DateS—.y 3 ri. Case . Name 3C •'. A4 M Number. - 2-0493-634-00—U , -. Worker uu .1t�� t �( - Jf Name ''i I. 'M—+j L/l� �\,i.. )�.. Nu�ber 4 F . R f3LtJt : , =r`54 DEC F I _ ;. Tik A Questions.yAsk your Worker ' � - - .' '- .::- :^ ' ' Sb txcestt• un• tr•dueclbn�dt'"�lto,.�1��-••gtr•b•�eder(•) (nDDifESSE� - " ISn Anj�bi iEn l�c�-.�lr mi. ;nn Sit, x! e+u„e>t•bin dtcs PRICE. � r../... t / }. - •_L Rrt,Y. i� A4 :_4, t tlG l Y'_:' -, `v ,.rr Y . °.. state,Hearing_,Jf you think this actiontsvvrol ng, you P T T TS B:I R G C A 9 45 6 5 t �`' ,,-�eahjasli fore"da'nng The beck of this` age tells hpw r 7 r r^ - Yo r benefits'may not be changed`if`You ask for at 5 heap b, ore this actionA10.40"Qla e a + F _Xr.. Y6iJ4t 'FC1Jt3 " $TAMPS'`l3EidEFITSF,. LHANGEf3. ' US59t1fJ 1 , 7tt =SSE „� 7 (2 ) THE NUMBER OF PEOPLE Yt3ilR NOUSA., C�l"fl s+i=hT TOWN OR r!a:"' l4 , + � 3 �t1UR: HQIJSNiItU'StF�(Ff €S rfAi�, DsORr f 'L Y ). r k(4 ? .A COMBINATION � It SONS (l�i(���+A�U�(�3�'. `< ��`� � 11> �� s .,a;: TA;MPs <CO'Wul AT #�E'"lE PEOPt IYU �HW ,L OL QU l~ A LN OR H0USa O T E � E �► a ,�t'r<3.*Ci•',�yf a )- �(C1UKi5, fl° STA{MP BNsE EFITSr H> ' x :Q iIP� 4 j � . FOOD STAMP #3t1iC;E SiiraMARY ©R 09/4 }�< t s^ � RN NGS ETY vt''� HH) ifNUM$ER` F P,,FRSONS ri K .4NW MAX A'LLOsdA# L:E ..GRcO3S _..INCOi�1£ ` 738"°Q(I� "� A�"`,�fG t n­% tik�. -•.a+*.-t,:- ti t ApJC1STEla GROSS ..,i~ARNE&nfJNCOME�;. ���r.lOt) — PttJS nTHER' INCCIME r r; 3�10�t70' .DEOLIGTI Otd �� AiDJUSJ;10 TWOIME,� +a .rs<trec<^:'u + t�xYc3s� rrtr r 3 r' 0 t G 1_,E7 � r NET 'X10 NT Hi.Y i frl C O M E �,�Q __ �- 'k w.:` » :,» •:�-• , t � f , Y :-�._ � _. �-...G 'wt_y,.. _..y. ..+�...sr•� r i ) THIS-IACT.€.ON IS REQUIRED BY 'frit FJLLOW-1 NG L'AWS-1,l t)-/UZ-:>.,itEGULA4YlONS,' -FOCO STA- 14? MANUAL SECTION 463-503 ELI.GI61LI TY AND r3ENt:i'IT LEy�t�LS' b3 504r.3i. 6i-504.4 _ UE a- 1 0 w N ..1 6« U - r r Appeals Unit Soclal Servi66Department UFA ,Y77.4DEC- ;EASE' I ="-` EF ITS — I, c 'm Ij rw' LJ CHANGE 42990N(5/87)!