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Cape May County Department of Transportation Certification Application (for persons under 60 ) Name: Address: Telephone Date of Birth: Social Security Emergency Contact: Telephone Income Eligible Information: A. Total Gross Wages/Salaries: B. Income from Self-Employed: C. Gross income from interest, Income/dividends/trusts: D. Gross income from Pensions: E. Social Security payments (all types): F. Unemployment and/or Workers Comp.: G. Alimony/child support: H. Other income: Total family income per month: Family Size: Applicants Signature: Please return this application to: Cape May County Department of Transportation 4 Moore Road Cape May Court House, NJ 08210-1601