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Click ‘Get Form’ to open the declaration patient form in the editor.
Begin by filling in your personal information, including your name, phone number, and address of the nursing home. Ensure all details are accurate and clearly printed.
Next, provide your spouse's information if applicable. This includes their name, phone number, and address. If there is no spouse, you can skip this section.
Complete the asset section by indicating whether you or your spouse have any assets. Check 'Yes' or 'No' and list all relevant assets such as bank accounts, real estate, vehicles, etc.
If applicable, answer questions regarding any recent transactions involving property or assets within the last 60 months. Be thorough to avoid issues later.
Finally, review the affidavit section carefully before signing. Ensure that all information provided is truthful and complete to avoid potential legal repercussions.

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Versions	Form popularity	Fillable & printable
2016	4.9 Satisfied (504 Votes)
2013	4.3 Satisfied (29 Votes)

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what is dhs 4487 unearned income notice

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