样本一
最低生活保障金申请书
（残疾人专用）
申请人姓名：________________ 性别：_____ 出生日期：_____年____月____日
民族：________________ 身份证号码：________________________________
户籍所在地：_____省_____市_____县（区）_____乡（镇、街道）_____村（社区）_____组（门牌号）
实际居住地：_____省_____市_____县（区）_____乡（镇、街道）_____村（社区）_____组（门牌号）
联系电话：________________ 残疾类别：________________ 残疾等级：_____级
残疾证号：________________________________
家庭人口：_____人 家庭月总收入：_________元 人均月收入：_________元
主要收入来源：
□ 工资性收入 _________元
□ 经营性收入 _________元
□ 财产性收入 _________元
□ 转移性收入 _________元 （如：养老金、退休金、失业保险金、赡养费、抚养费、扶养费等）
□ 其他收入 _________元
家庭财产状况：
□ 房产：_____处，面积_____平方米，价值_____元 （请附房产证复印件或相关证明）
□ 车辆：_____辆，价值_____元 （请附行驶证复印件）
□ 银行存款：_____元 （请附银行存折复印件或银行流水）
□ 其他贵重物品：________________________________ （请详细说明）
申请理由：（请详细描述家庭经济困难情况、残疾情况、主要致困原因等，可另附纸张）
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