Submit Date 04/26/2025

Submit Time 09:12 AM EST

Renewal Summary
Programs Food Assistance (SNAP)

Health Coverage (Medicaid)

Your Information
Main Applicant JORGE MOHAR (34)
First Name JORGE
Middle Name
Last Name MOHAR
Suffix
Other Names
Are you a resident of Florida? Yes
Are you applying for benefits for yourself? Yes
Living Situation Home/Apartment/Trailer
Date child removed
Date child returned
Are you experiencing homelessness? No
Which city are you currently in?
What state are you currently in?
What's the zip code where you are currently
staying?
Temporarily Mailing Address
Where do you currently live? 9999 NW 23rd Ave,Miami,Florida,33147

Do you get your mail at a different address? No

Where do you receive your mail?

Home Phone
Mobile Phone (786) 685-7880
Work Phone/Alternate Phone
Email
Would you like to get text messages about
your benefits?
Would you like to receive email notifications
instead of paper mail?
Date of Birth 02/04/1991
What's your gender? Male
Do you have a Social Security number? Yes
What's your Social Security number? 335-53-6689
Why don't you have a Social Security number?
Please explain.

Have you applied for an Social Security

number?
Have you ever used a different Social Security No
number?
What Social Security number have you used?
SSN Type
First Name
Last Name
Name Type
Marital Status Married
In what country were you born? Cuba
Have you been outside of the U.S. in the last 30 No
days?
Are you a U.S. citizen or national? No
Date Entered U.S. (if you know) 02/12/2022
Date Left the U.S. (if you know)
Immigration Document Type

Immigration Document Number 240213958

Date Document Issued by USCIS (if you know) 02/12/2022

Have you lived in the U.S. continuously since

1996?
Are you a spouse or parent of a veteran or an
active-duty member of the U.S. military?
Have you been granted asylum in the U.S.? No
Date Asylum Granted
Have you had a medical emergency in the U.S. No
in the past 3 months?
Type
Date
Are you a sponsored noncitizen? No
Type
Sponsor ID
Name
Phone
Do you have, applied for, or plan to apply for
the following: T-Visa, U-Visa, Violence Against
Women Act (VAWA) petition
Did your immigration status change in the last
12 months?
What's changed?

Date of Change
Alien Number 240213958
Are you of Hispanic, Latino, or Spanish origin? Yes
What is your race? White

Are you a member of a federally recognized

tribe?
Tribe Name
Did you ever get a service from, or did
someone refer you to, Indian Health Service or
Tribal Health Programs?
Are you eligible to get services from the Indian
Health Services, tribal health programs or
through a referral from one of these
programs?

People
People
Do you have other people living in your Yes
household?

Household Member1 YAIRIS PEREZ (41)

First Name YAIRIS
Middle Name
Last Name PEREZ
Suffix
Other Names
How is YAIRIS related to you? Mother
Programs SNAP,Medicaid
Do you buy and prepare food with YAIRIS ? No

Is YAIRIS a resident of Florida? Yes

What is YAIRIS living situation? Home/Apartment/Trailer
Home Phone
Mobile Phone
Work Phone/Alternate Phone
Email
Date of Birth 08/12/1983
What's your gender? Female
Does YAIRIS have a Social Security number? Yes

What's your Social Security number? 726-20-2822

Why doesn't YAIRIS have a Social Security
number?
Please explain.

Has YAIRIS applied for a Social Security

number?
Has YAIRIS ever used a different Social No
Security number?
What Social Security number has YAIRIS used?

SSN Type
First Name
Last Name
Name Type
Marital Status Married
In what country was YAIRIS born? Cuba
Has YAIRIS been outside of the U.S. in the last No
30 days?
Date Left the U.S.
Date Returned to the U.S.
Is YAIRIS a U.S. citizen or national? No
Date Entered U.S. (if you know) 02/12/2022
Date Left the U.S. (if you know)
Immigration Document Type Permanent Resident Card (Green Card, I-551)
Immigration Document Number 220200015
Date Document Issued by USCIS (if you know) 02/12/2022

Has YAIRIS lived in the U.S. continuously since No

1996?
Are you a spouse or parent of a veteran or an No
active-duty member of the U.S. military?
Have you been granted asylum in the U.S.? No
Date Asylum Granted
Have you had a medical emergency in the U.S. No
in the past 3 months?
Type
Date
Is YAIRIS a sponsored noncitizen? No
Type
Sponsor ID
Name
Phone
Sponsor Address
Does YAIRIS have, applied for, or plan to apply No
for the following: T-Visa, U-Visa, Violence
Against Women Act (VAWA) petition
Did YAIRIS's immigration status change in the No
last 12 months?
What's changed?

Date of change
Alien Number (if applicable)
Is YAIRIS of Hispanic, Latino, or Spanish Yes
origin?
What is YAIRIS's race? White

Is YAIRIS a member of a federally recognized

tribe?
Tribe Name
Did you ever get a service from, or did
someone refer you to, Indian Health Service or
Tribal Health Programs?
Are you eligible to get services from the Indian
Health Services, tribal health programs or
through a referral from one of these
programs?
Are YAIRIS's shots (immunizations) up to date?
Household Member2 JEREMY MOHAR (6)
First Name JEREMY
Middle Name
Last Name MOHAR
Suffix
Other Names
How is JEREMY related to you? Son
Programs SNAP,Medicaid
Do you buy and prepare food with JEREMY ? No

Is JEREMY a resident of Florida? Yes

What is JEREMY living situation? Home/Apartment/Trailer
Home Phone
Mobile Phone
Work Phone/Alternate Phone
Email
Date of Birth 03/28/2019
What's your gender? Male
Does JEREMY have a Social Security number? Yes

What's your Social Security number? 057-83-8148

Why doesn't JEREMY have a Social Security
number?
Please explain.

Has JEREMY applied for a Social Security

number?
Has JEREMY ever used a different Social No
Security number?
What Social Security number has JEREMY
used?
SSN Type
First Name
Last Name
Name Type
Marital Status Single - Never Married
In what country was JEREMY born? Cuba
Has JEREMY been outside of the U.S. in the last No
30 days?
Date Left the U.S.
Date Returned to the U.S.
Is JEREMY a U.S. citizen or national? No
Date Entered U.S. (if you know) 02/12/2022
Date Left the U.S. (if you know)
Immigration Document Type Permanent Resident Card (Green Card, I-551)
Immigration Document Number 220200015
Date Document Issued by USCIS (if you know) 02/12/2022

Has JEREMY lived in the U.S. continuously No

since 1996?
Are you a spouse or parent of a veteran or an No
active-duty member of the U.S. military?
Have you been granted asylum in the U.S.? No
Date Asylum Granted
Have you had a medical emergency in the U.S. No
in the past 3 months?
Type
Date
Is JEREMY a sponsored noncitizen? No
Type
Sponsor ID
Name
Phone
Sponsor Address
Does JEREMY have, applied for, or plan to No
apply for the following: T-Visa, U-Visa,
Violence Against Women Act (VAWA) petition
Did JEREMY's immigration status change in No
the last 12 months?
What's changed?

Date of change
Alien Number (if applicable)
Is JEREMY of Hispanic, Latino, or Spanish Yes
origin?
What is JEREMY's race? White

Is JEREMY a member of a federally recognized

tribe?
Tribe Name
Did you ever get a service from, or did
someone refer you to, Indian Health Service or
Tribal Health Programs?
Are you eligible to get services from the Indian
Health Services, tribal health programs or
through a referral from one of these
programs?
Are JEREMY's shots (immunizations) up to
date?

Household Details
College/Vocational School JEREMY MOHAR (6)
School Name Edison Private
School County
School Type Elementary
Enrollment Status Full Time
Participating in work study program?
Expected Graducation Date
Current Education Level
Is anyone attending a school conference for
JEREMY?
Who Attended
Date of Last School Conference
Income
Job/Income JORGE MOHAR (34)
Employer's Name EDDY MARTINEZ PLUMBING
Employer's Address

Employer's Phone
Start Date 05/13/2024
How often paid? Twice A Month
Amount $ 2000.00
Average Hours per Week 40.0
Tips Amount
Commission Amount

Expenses
Rent JORGE MOHAR (34)
Amount $ 2500.00
How often? Monthly
Does anyone outside of your household help No
JORGE pay for this expense?
Does Section 8 or HUD help you pay for this No
expense?
Section 8 or HUD Amount

Gas, Electric, Coal/Wood, or Other Fuel JORGE MOHAR (34)

Type Electric
Amount $ 100.00
How often? Monthly
Does anyone outside of your household help No
JORGE pay for this expense?
Does this heat or cool your home/apartment? No
Does Section 8 or HUD help you pay for this No
expense?
Section 8 or HUD Amount

Telephone/Mobile Phone JORGE MOHAR (34)

Amount $ 150.00
How often? Monthly
Does anyone outside of your household help No
JORGE pay for this expense?
Does Section 8 or HUD help you pay for this No
expense?
Section 8 or HUD Amount

Student Expenses JEREMY MOHAR (6)

Student Expense Type Books / Supplies
Amount $ 500.00
Start Date 08/19/2024
End Date 06/19/2025
Blind Work Related Expenses JORGE MOHAR (34)
Work Expense Type Braille Instr./Translation
Amount $ 50.00
How often? Weekly
Does anyone outside of your household help No
JORGE pay for this expense?

Blind Work Related Expenses JORGE MOHAR (34)

Work Expense Type Tools Needed On Job
Amount $ 100.00
How often? Monthly
Does anyone outside of your household help
JORGE pay for this expense?

Assets
Checking Account YAIRIS PEREZ (41)
Amount $ 400.00
Where Held
Is this jointly owned? Yes
Who is it joint with? JORGE MOHAR (34)
First Name JORGE
Last Name MOHAR
What percentage do they own? 50.0%
Will a part of the value of this asset pay for
future burial costs?
If yes, how much?

Checking Account JORGE MOHAR (34)

Amount $ 3000.00
Where Held
Is this jointly owned? Yes
Who is it joint with? YAIRIS PEREZ (41)
First Name YAIRIS
Last Name PEREZ
What percentage do they own? 50.0%
Will a part of the value of this asset pay for
future burial costs?
If yes, how much?
Vehicles JORGE MOHAR (34)
Year 1999
Make (Ford, Chevy)
Model (F-150, Malibu)
Estimated Value
Amount Owed
Is this vehicle registered(current tag)? Yes
Does JORGE have access to, and use this Yes
vehicle?
How is it being used? For work or school transportation

Is this jointly owned? No

Who is it joint with?
What percentage do you own?
Will a part of the value pay for future burial
costs?
If yes, how much?

Vehicles YAIRIS PEREZ (41)

Year 2016
Make (Ford, Chevy)
Model (F-150, Malibu)
Estimated Value
Amount Owed
Is this vehicle registered(current tag)? Yes
Does YAIRIS have access to, and use this Yes
vehicle?
How is it being used? For work or school transportation

Is this jointly owned? Yes

Who is it joint with? JORGE MOHAR
What percentage do you own? 50.0%
Will a part of the value pay for future burial
costs?
If yes, how much?

Other Situations
Convictions and Felony
Convicted of receiving duplicate food No
assistance,Medicaid, or Cash Assistance in any
state after 08/22/1996?
Convicted of sharing or selling EBT cards No
worth $500 or more after 08/22/1996?
Found guilty of Drug Trafficking or trading No
food assistance for drugs in any state after
08/22/1996?
Found guilty of trading food assistance for No
guns, ammunitions, or explosives after
Hiding or running from the law for a felony No
crime or attempted felony crime? (This could
be to avoid prosecution, being taken into
custody, or going to jail.)

Aggravated sexual abuse, murder, sexual No

exploitation and other related abuse of
children, Federal or State offense involving
sexual assault, or an offense under state law
similar to crimes listed, after February 7,
2014?

Review & Submit

Review & Submit
Is there anything else you would like us to
know?

Do you want to register to vote at your current

address
Do you give permission to DCF to request your
financial records, to confirm the asset
information provided?

Main Applicant Signature

First Name Jorge
Last Name Mohar
Date 04/26/2025
I confirm that I read, or had read to you, and Yes
understand and agree to the Rights and
Responsibilities.