{"id":5562,"date":"2025-05-13T17:27:09","date_gmt":"2025-05-13T23:27:09","guid":{"rendered":"https:\/\/veteran-affairs-louisiana.local\/?page_id=5562"},"modified":"2025-07-07T09:33:34","modified_gmt":"2025-07-07T14:33:34","slug":"fundo-de-assistencia-para-familias-militares","status":"publish","type":"page","link":"https:\/\/vetaffairs.la.gov\/pt\/fundo-de-assistencia-para-familias-militares","title":{"rendered":"Fundo de Assist\u00eancia para Fam\u00edlias Militares"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"5562\" class=\"elementor elementor-5562\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-09f0e0b e-flex e-con-boxed e-con e-parent\" data-id=\"09f0e0b\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0fcae54 elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile elementor-widget elementor-widget-text-editor\" data-id=\"0fcae54\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>O Fundo de Assist\u00eancia \u00e0s Fam\u00edlias Militares (MFA) pode fornecer apoio financeiro a veteranos da Louisiana e suas fam\u00edlias quando enfrentam dificuldades financeiras. Certos crit\u00e9rios se aplicam. Para receber fundos atrav\u00e9s do MFA, um formul\u00e1rio de inscri\u00e7\u00e3o preenchido deve ser enviado ao LDVA, incluindo toda a documenta\u00e7\u00e3o comprobat\u00f3ria necess\u00e1ria. O MFA pode pagar at\u00e9 US$ 1.000,00 por solicita\u00e7\u00e3o, por ordem de servi\u00e7o ativo, em um per\u00edodo de doze meses.<\/p><p>A MFA \u00e9 financiada por doa\u00e7\u00f5es privadas de indiv\u00edduos e empresas. Visite nossa p\u00e1gina &quot;Como Ajudar&quot; para fazer uma doa\u00e7\u00e3o para o fundo da MFA.<\/p><p><strong>Qualifica\u00e7\u00f5es:<\/strong> Para se qualificar para receber assist\u00eancia do Fundo MFA, veteranos e militares da ativa devem atender a certos requisitos m\u00ednimos de servi\u00e7o ativo e ter recebido baixa honrosa. Familiares imediatos de veteranos e militares da ativa eleg\u00edveis tamb\u00e9m podem se qualificar. Os formul\u00e1rios de inscri\u00e7\u00e3o preenchidos devem incluir todos os documentos comprobat\u00f3rios solicitados.<\/p><p>Para obter mais informa\u00e7\u00f5es, voc\u00ea pode ligar gratuitamente. <a href=\"tel:18774328982\">1-877-432-8982<\/a>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b52bd99 elementor-widget elementor-widget-text-editor\" data-id=\"b52bd99\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>O Fundo de Assist\u00eancia \u00e0s Fam\u00edlias Militares (MFA, na sigla em ingl\u00eas) oferece aux\u00edlio financeiro a veteranos da Louisiana e membros da Guarda Nacional ou da Reserva da Louisiana que atendam aos requisitos de elegibilidade. O Conselho do MFA pode aprovar aux\u00edlio no valor de at\u00e9 10.000 d\u00f3lares para uma solicita\u00e7\u00e3o baseada em necessidade, em um per\u00edodo de 12 meses.<\/p><p>Veteranos das For\u00e7as Armadas que receberam baixa honrosa ou sob condi\u00e7\u00f5es honrosas, ou membros ativos da Guarda Nacional da Louisiana (LANG) ou da Reserva em situa\u00e7\u00e3o regular com sua unidade, que sejam residentes atuais da Louisiana, s\u00e3o eleg\u00edveis para receber assist\u00eancia. O Fundo de Assist\u00eancia \u00e0 Fam\u00edlia Militar tradicionalmente cobre despesas com moradia, servi\u00e7os p\u00fablicos, alguns servi\u00e7os m\u00e9dicos e outras despesas essenciais que causem dificuldades financeiras ao veterano ou membro da LANG ou da Reserva.<\/p><p>Veteranos da Louisiana ou membros atuais da Guarda Nacional ou da Reserva da Louisiana podem enviar uma inscri\u00e7\u00e3o online ou\u00a0<a href=\"\/wp-content\/uploads\/2021\/09\/MFAApplication.pdf\" target=\"_blank\" rel=\"noopener\">Preencha um formul\u00e1rio em PDF.<\/a> e envie por e-mail para <a href=\"mailto:holly.talley@la.gov\">holly.talley@la.gov <\/a>ou envie por fax para (225) 219-5590, ou por correio para Louisiana Department of Veterans Affairs, ATTN: MFA Administrator, PO Box 94095, Baton Rouge, LA 70804-9095. Os candidatos tamb\u00e9m podem solicitar o envio de um formul\u00e1rio de inscri\u00e7\u00e3o por e-mail para o endere\u00e7o listado acima ou por telefone. <a href=\"tel:2252193700\">(225) 219-3700<\/a>.<\/p><p>Observa\u00e7\u00e3o: Para processar todas as solicita\u00e7\u00f5es da forma mais eficiente poss\u00edvel, certifique-se de enviar uma solicita\u00e7\u00e3o completa com todos os documentos necess\u00e1rios. Os fundos n\u00e3o s\u00e3o disponibilizados imediatamente ap\u00f3s o envio, pois todas as solicita\u00e7\u00f5es s\u00e3o analisadas pelo Conselho do Fundo de Assist\u00eancia \u00e0s Fam\u00edlias Militares em sua reuni\u00e3o mensal regular.<\/p><p>Indiv\u00edduos podem apoiar os veteranos da Louisiana e os membros atuais da Guarda Nacional ou da Reserva da Louisiana fazendo uma doa\u00e7\u00e3o:<\/p><ul><li><a href=\"\/pt\/doar\/\">On-line<\/a><\/li><li>Por correio para: Departamento de Assuntos de Veteranos da Louisiana<br \/>A\/C: Administrador de MFA<br \/>Caixa Postal 94095<br \/>Baton Rouge, LA 70804-9095<\/li><li>Em uma declara\u00e7\u00e3o de imposto de renda individual ou corporativa da Louisiana.<\/li><li>Ao solicitar qualquer tipo de licen\u00e7a no Departamento de Ve\u00edculos Motorizados<\/li><li>Ao adquirir placas de ve\u00edculos com os dizeres &quot;Apoie Nossos Veteranos&quot; e &quot;Apoie Nossas Tropas&quot; no Departamento de Ve\u00edculos Motorizados (DMV).<\/li><\/ul><p>Para obter mais informa\u00e7\u00f5es sobre o Fundo de Assist\u00eancia \u00e0s Fam\u00edlias Militares ou ajuda com uma inscri\u00e7\u00e3o, ligue para <a href=\"tel:2252193700\">(225) 219-3700<\/a> ou e-mail <a href=\"mailto:holly.talley@la.gov\">holly.talley@la.gov<\/a>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6f2f74e elementor-widget elementor-widget-heading\" data-id=\"6f2f74e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Solicite financiamento do Minist\u00e9rio das Rela\u00e7\u00f5es Exteriores<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7d2559a mfa-form elementor-widget elementor-widget-shortcode\" data-id=\"7d2559a\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div 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   <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_5' class='mfa-form' action='\/pt\/wp-json\/wp\/v2\/pages\/5562#gf_5' data-formid='5' novalidate data-trp-original-action=\"\/pt\/wp-json\/wp\/v2\/pages\/5562#gf_5\">\t\t\t\t\t<div style=\"display: none !important;\" class=\"akismet-fields-container gf_invisible\" data-prefix=\"ak_\">\n\t\t\t\t\t\t<label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label>\n\t\t\t\t\t\t<input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"55\" \/>\n\t\t\t\t\t\t<script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n\n\t\t\t\t\t<\/div><div class='gf_invisible ginput_recaptchav3'  data-tabindex='0'><input id=\"input_b996350b1bc3f639e62173210a79ccf2\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_b996350b1bc3f639e62173210a79ccf2\" value=\"\"\/><\/div>\n        <div id='gf_progressbar_wrapper_5' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Etapa <span class='gf_step_current_page'>1<\/span> de <span class='gf_step_page_count'>7<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_14' style='width:14%;'><span>14%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_5_1' class='gform_page' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_124\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full sub-text gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Observa\u00e7\u00e3o: Se preferir n\u00e3o se candidatar online, fa\u00e7a o download do formul\u00e1rio. <a href=\"\/wp-content\/uploads\/2021\/09\/MFAApplication.pdf\" target=\"_blank\">aplicativo PDF preench\u00edvel<\/a> aqui.<\/p><\/div><fieldset id=\"field_5_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nome<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_5_1'>\n                            \n                            <span id='input_5_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_5_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                    <label for='input_5_1_3' class='gform-field-label gform-field-label--type-sub'>Primeiro<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_5_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                    <label for='input_5_1_6' class='gform-field-label gform-field-label--type-sub'>Durar<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_3\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_3'>Rela\u00e7\u00e3o com o veterano<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_5_3' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Selecionar relacionamento<\/option><option value='Veteran' >Veterano<\/option><option value='Spouse' >C\u00f4njuge<\/option><option value='Child' >Crian\u00e7a<\/option><option value='Other' >Outro<\/option><\/select><\/div><\/div><div id=\"field_5_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_4'>Outro<\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_5_4' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_5_8\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Endere\u00e7o<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_5_8' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_8_1_container' >\n                                        <input type='text' name='input_8.1' id='input_5_8_1' value=''    aria-required='true'   autocomplete=\"address-line1\" \/>\n                                        <label for='input_5_8_1' id='input_5_8_1_label' class='gform-field-label gform-field-label--type-sub'>Endere\u00e7o da Rua<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_5_8_3_container' >\n                                    <input type='text' name='input_8.3' id='input_5_8_3' value=''    aria-required='true'   autocomplete=\"address-level2\" \/>\n                                    <label for='input_5_8_3' id='input_5_8_3_label' class='gform-field-label gform-field-label--type-sub'>Cidade<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_5_8_4_container' >\n                                        <select name='input_8.4' id='input_5_8_4'     aria-required='true'   autocomplete=\"address-level1\" ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alasca<\/option><option value='American Samoa' >Samoa Americana<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >Calif\u00f3rnia<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >Distrito de Col\u00fambia<\/option><option value='Florida' >Fl\u00f3rida<\/option><option value='Georgia' >Ge\u00f3rgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hava\u00ed<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' selected='selected'>Luisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >Nova Hampshire<\/option><option value='New Jersey' >Nova Jersey<\/option><option value='New Mexico' >Novo M\u00e9xico<\/option><option value='New York' >Nova Iorque<\/option><option value='North Carolina' >Carolina do Norte<\/option><option value='North Dakota' >Dakota do Norte<\/option><option value='Northern Mariana Islands' >Ilhas Marianas do Norte<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pensilv\u00e2nia<\/option><option value='Puerto Rico' >Porto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >Carolina do Sul<\/option><option value='South Dakota' >Dakota do Sul<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >Ilhas Virgens Americanas<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virg\u00ednia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >Virg\u00ednia Ocidental<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >For\u00e7as Armadas das Am\u00e9ricas<\/option><option value='Armed Forces Europe' >For\u00e7as Armadas da Europa<\/option><option value='Armed Forces Pacific' >For\u00e7as Armadas do Pac\u00edfico<\/option><\/select>\n                                        <label for='input_5_8_4' id='input_5_8_4_label' class='gform-field-label gform-field-label--type-sub'>Estado<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_8_5_container' >\n                                    <input type='text' name='input_8.5' id='input_5_8_5' value=''    aria-required='true'   autocomplete=\"postal-code\" \/>\n                                    <label for='input_5_8_5' id='input_5_8_5_label' class='gform-field-label gform-field-label--type-sub'>CEP<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_8.6' id='input_5_8_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_7\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_7'>Por favor, selecione sua par\u00f3quia.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_5_7' class='large gfield_select'  aria-describedby=\"gfield_description_5_7\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Selecione a par\u00f3quia<\/option><option value='Acadia' >Ac\u00e1dia<\/option><option value='Allen' >Allen<\/option><option value='Ascension' >Ascens\u00e3o<\/option><option value='Assumption' >Suposi\u00e7\u00e3o<\/option><option value='Avoyelles' >Avoyelles<\/option><option value='Beauregard' >Beauregard<\/option><option value='Bienville' >Bienville<\/option><option value='Bossier' >Mais mand\u00e3o<\/option><option value='Caddo' >Caddo<\/option><option value='Calcasieu' >Calcasieu<\/option><option value='Caldwell' >Caldwell<\/option><option value='Cameron' >Cameron<\/option><option value='Catahoula' >Catahoula<\/option><option value='Claiborne' >Claiborne<\/option><option value='Concordia' >Concordia<\/option><option value='De Soto' >De Soto<\/option><option value='East Baton Rouge' >Leste de Baton Rouge<\/option><option value='East Carroll' >East Carroll<\/option><option value='East Feliciana' >Feliciana Oriental<\/option><option value='Evangeline' >Evangelina<\/option><option value='Franklin' >Franklin<\/option><option value='Grant' >Conceder<\/option><option value='Iberia' >Pen\u00ednsula Ib\u00e9rica<\/option><option value='Iberville' >Iberville<\/option><option value='Jackson' >Jackson<\/option><option value='Jefferson' >Jefferson<\/option><option value='Jefferson Davis' >Jefferson Davis<\/option><option value='La Salle' >La Salle<\/option><option value='Lafayette' >Lafayette<\/option><option value='Lafourche' >Lafourche<\/option><option value='Lincoln' >Lincoln<\/option><option value='Livingston' >Livingston<\/option><option value='Madison' >Madison<\/option><option value='Morehouse' >Morehouse<\/option><option value='Natchitoches' >Natchitoches<\/option><option value='Orleans' >Orleans<\/option><option value='Ouachita' >Ouachita<\/option><option value='Plaquemines' >Plaqueminas<\/option><option value='Pointe Coupee' >Pointe Coupee<\/option><option value='Rapides' >Rapides<\/option><option value='Red River' >Rio Vermelho<\/option><option value='Richland' >Terra Rica<\/option><option value='Sabine' >Sabina<\/option><option value='St. Bernard' >S\u00e3o Bernardo<\/option><option value='St. Charles' >S\u00e3o Carlos<\/option><option value='St. Helena' >Santa Helena<\/option><option value='St. James' >S\u00e3o Tiago<\/option><option value='St. John The Baptist' >S\u00e3o Jo\u00e3o Batista<\/option><option value='St. Landry' >S\u00e3o Landry<\/option><option value='St. Martin' >S\u00e3o Martinho<\/option><option value='St. Mary' >Santa Maria<\/option><option value='St. Tammany' >St. Tammany<\/option><option value='Tangipahoa' >Tangipahoa<\/option><option value='Tensas' >Tensas<\/option><option value='Terrebonne' >Terrebonne<\/option><option value='Union' >Uni\u00e3o<\/option><option value='Vermilion' >Vermelh\u00e3o<\/option><option value='Vernon' >Vernon<\/option><option value='Washington' >Washington<\/option><option value='Webster' >Webster<\/option><option value='West Baton Rouge' >Oeste de Baton Rouge<\/option><option value='West Carroll' >West Carroll<\/option><option value='West Feliciana' >Feliciana Ocidental<\/option><option value='Winn' >Ganhar<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_5_7'>Por favor, selecione a par\u00f3quia onde voc\u00ea reside atualmente na lista acima.<\/div><\/div><div id=\"field_5_9\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_9'>E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_9' id='input_5_9' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_5_9\" autocomplete=\"email\"\/>\n                        <\/div><div class='gfield_description' id='gfield_description_5_9'>Formato: nome de usu\u00e1rio@dominio.com<\/div><\/div><div id=\"field_5_10\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_10'>Celular<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_5_10' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_5_10\" autocomplete=\"tel\" \/><\/div><div class='gfield_description' id='gfield_description_5_10'>Formato: (123) 456-7890<\/div><\/div><div id=\"field_5_11\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_11'>Telefone residencial<\/label><div class='ginput_container ginput_container_phone'><input name='input_11' id='input_5_11' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_5_11\"  \/><\/div><div class='gfield_description' id='gfield_description_5_11'>Formato: (123) 456-7890<\/div><\/div><div id=\"field_5_12\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_12'>Telefone comercial<\/label><div class='ginput_container ginput_container_phone'><input name='input_12' id='input_5_12' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_5_12\"  \/><\/div><div class='gfield_description' id='gfield_description_5_12'>Formato: (123) 456-7890<\/div><\/div><div id=\"field_5_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_13'>Estado civil<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_5_13' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_14\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_14'>Licen\u00e7a de casamento<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_14' id='input_5_14' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_14\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_14'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_14'><\/div> <\/div><\/div><div id=\"field_5_15\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_15'>Certid\u00e3o de Nascimento ou Procura\u00e7\u00e3o<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_15' id='input_5_15' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_15\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_15'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_15'><\/div> <\/div><\/div><div id=\"field_5_16\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_16'>N\u00famero de dependentes\/crian\u00e7as no domic\u00edlio<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_16' id='input_5_16' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_5_17\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_17'>Identifica\u00e7\u00e3o com foto para veteranos<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_17' id='input_5_17' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_17\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_17'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_17'><\/div> <\/div><\/div><div id=\"field_5_18\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_5_18'>Documento de identifica\u00e7\u00e3o com foto do c\u00f4njuge ou de outras pessoas maiores de 18 anos.<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_18' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_18&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_18&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_18&quot;,&quot;filelist&quot;:&quot;gform_preview_5_18&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:18,&quot;_gform_file_upload_nonce_5_18&quot;:&quot;1daccdcc5d&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_18&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_18' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Solte os arquivos aqui ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_18' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_18\"  >Selecionar arquivos<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_18'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_18'><\/ul> <div id='gform_preview_5_18' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_5_42\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Este campo fica oculto ao visualizar o formul\u00e1rio.\"><\/i><span>Este campo fica oculto ao visualizar o formul\u00e1rio.<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_42'>Idades das crian\u00e7as<\/label><div class='ginput_container ginput_container_number'><input name='input_42' id='input_5_42' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_5_43\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Este campo fica oculto ao visualizar o formul\u00e1rio.\"><\/i><span>Este campo fica oculto ao visualizar o formul\u00e1rio.<\/span><\/div><label class='gfield_label gform-field-label' for='input_5_43'>Necessidades especiais?<\/label><div class='ginput_container ginput_container_number'><input name='input_43' id='input_5_43' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_5_147\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_147'>Idades das crian\u00e7as<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_147' id='input_5_147' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_148\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_148'>Necessidades especiais<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_148' id='input_5_148' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_5_132' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Pr\u00f3ximo'  \/> <button type='button'  id='gform_save_5_2_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> SALVAR E CONTINUAR MAIS TARDE<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_2' class='gform_page' data-js='page-field-id-132' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_140\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informa\u00e7\u00f5es de contato de veteranos\/militares<\/h3><div class='gsection_description' id='gfield_description_5_140'>Esta informa\u00e7\u00e3o destina-se apenas ao veterano, caso ele\/ela n\u00e3o seja o(a) requerente.<\/div><\/div><div id=\"field_5_23\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_23'>Endere\u00e7o de email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_23' id='input_5_23' type='email' value='' class='large'     aria-invalid=\"false\" aria-describedby=\"gfield_description_5_23\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_5_23'>Formato: nome de usu\u00e1rio@dominio.com<\/div><\/div><div id=\"field_5_24\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_24'>Telefone residencial<\/label><div class='ginput_container ginput_container_phone'><input name='input_24' id='input_5_24' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_5_24\"  \/><\/div><div class='gfield_description' id='gfield_description_5_24'>Formato: (123) 456-7890<\/div><\/div><div id=\"field_5_25\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_25'>Celular<\/label><div class='ginput_container ginput_container_phone'><input name='input_25' id='input_5_25' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_5_25\"  \/><\/div><div class='gfield_description' id='gfield_description_5_25'>Formato: (123) 456-7890<\/div><\/div><div id=\"field_5_26\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_26'>Telefone comercial<\/label><div class='ginput_container ginput_container_phone'><input name='input_26' id='input_5_26' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_5_26\"  \/><\/div><div class='gfield_description' id='gfield_description_5_26'>Formato: (123) 456-7890<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_133' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Anterior'  \/> <input type='button' id='gform_next_button_5_133' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Pr\u00f3ximo'  \/> <button type='button'  id='gform_save_5_3_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> SALVAR E CONTINUAR MAIS TARDE<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_3' class='gform_page' data-js='page-field-id-133' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_141\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Informa\u00e7\u00f5es para veteranos\/militares<\/h3><div class='gsection_description' id='gfield_description_5_141'>Conforme consta no DD214 ou nas Ordens Militares.<\/div><\/div><fieldset id=\"field_5_149\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Atualmente estou servindo<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_149'>\n\t\t\t<div class='gchoice gchoice_5_149_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_149' type='radio' value='Present'  id='choice_5_149_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_149_0' id='label_5_149_0' class='gform-field-label gform-field-label--type-inline'>Sim<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_149_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_149' type='radio' value='No'  id='choice_5_149_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_149_1' id='label_5_149_1' class='gform-field-label gform-field-label--type-inline'>N\u00e3o<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_28\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_28'>DD214 ou Alta<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_28' id='input_5_28' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_28\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_28'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_28'><\/div> <\/div><\/div><fieldset id=\"field_5_29\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nome<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_5_29'>\n                            \n                            <span id='input_5_29_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.3' id='input_5_29_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_29_3' class='gform-field-label gform-field-label--type-sub'>Primeiro<\/label>\n                                                <\/span>\n                            <span id='input_5_29_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.4' id='input_5_29_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_29_4' class='gform-field-label gform-field-label--type-sub'>Meio<\/label>\n                                                <\/span>\n                            <span id='input_5_29_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_29.6' id='input_5_29_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_29_6' class='gform-field-label gform-field-label--type-sub'>Durar<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_5_30\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Residente atual de Los Angeles?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_30'>\n\t\t\t<div class='gchoice gchoice_5_30_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Yes'  id='choice_5_30_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_30_0' id='label_5_30_0' class='gform-field-label gform-field-label--type-inline'>Sim<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_30_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='No'  id='choice_5_30_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_30_1' id='label_5_30_1' class='gform-field-label gform-field-label--type-inline'>N\u00e3o<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_31\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_31'>Ramo de servi\u00e7o<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_5_31' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_32'>Classifica\u00e7\u00e3o<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_5_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_34\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_34'>Total de anos de servi\u00e7o<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_34' id='input_5_34' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_5_35\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_35'>Entrou em servi\u00e7o<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_35' id='input_5_35' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/aaaa' aria-describedby=\"input_5_35_date_format gfield_description_5_35\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_35_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_35' class='gform_hidden' value='https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_5_35'>Formato: mm\/dd\/aaaa<\/div><\/div><div id=\"field_5_36\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_36'>Deixou o servi\u00e7o<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_36' id='input_5_36' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/aaaa' aria-describedby=\"input_5_36_date_format gfield_description_5_36\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_36_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_36' class='gform_hidden' value='https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_5_36'>Formato: mm\/dd\/aaaa<\/div><\/div><div id=\"field_5_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_37'>Unidade de atribui\u00e7\u00e3o (se estiver atualmente atribu\u00eddo)<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_5_37' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_41\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_41'>Data de ativa\u00e7\u00e3o (se estiver ativado)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_41' id='input_5_41' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/aaaa' aria-describedby=\"input_5_41_date_format gfield_description_5_41\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_41_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_41' class='gform_hidden' value='https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_5_41'>Formato: mm\/dd\/aaaa<\/div><\/div><fieldset id=\"field_5_38\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Voc\u00ea \u00e9 membro atual da Guarda Nacional ou da Reserva de Los Angeles?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_5_38'>\n\t\t\t<div class='gchoice gchoice_5_38_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Yes'  id='choice_5_38_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_38_0' id='label_5_38_0' class='gform-field-label gform-field-label--type-inline'>Sim<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_5_38_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='No'  id='choice_5_38_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_5_38_1' id='label_5_38_1' class='gform-field-label gform-field-label--type-inline'>N\u00e3o<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_40\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_40'>Ordens Militares<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_40' id='input_5_40' type='file' class='large' aria-describedby=\"gfield_upload_rules_5_40\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_40'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_5_40'><\/div> <\/div><\/div><div id=\"field_5_166\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Ponto de contato da unidade militar para verifica\u00e7\u00e3o<\/h3><div class='gsection_description' id='gfield_description_5_166'>(Somente para membros da Guarda Nacional\/Reserva\/Servi\u00e7o Ativo)<\/div><\/div><div id=\"field_5_167\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_167'>Nome da unidade<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_167' id='input_5_167' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_168\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_168'>Cargo\/T\u00edtulo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_168' id='input_5_168' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_169\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_169'>Endere\u00e7o de e-mail para contato da unidade<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_169' id='input_5_169' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_5_169\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_5_169'>Formato: nome de usu\u00e1rio@dominio.com<\/div><\/div><div id=\"field_5_170\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_170'>N\u00famero de telefone comercial para contato da unidade<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_170' id='input_5_170' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_171\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_171'>N\u00famero de fax para contato da unidade<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_171' id='input_5_171' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_174\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><div class='gsection_description' id='gfield_description_5_174'>Atesto que as informa\u00e7\u00f5es fornecidas neste formul\u00e1rio s\u00e3o verdadeiras e corretas, de acordo com o meu melhor conhecimento. Compreendo que n\u00e3o h\u00e1 garantia de que meu pedido ser\u00e1 aprovado. Compreendo tamb\u00e9m que, se meu pedido for aprovado, a assist\u00eancia ser\u00e1, na maioria dos casos, paga diretamente ao prestador de servi\u00e7os e n\u00e3o a mim.<\/div><\/div><div id=\"field_5_172\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_172'>Assinatura<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_5_172_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><input type='hidden' class='gform_hidden' name='input_5_172_valid' id='input_5_172_valid' \/><canvas id='input_5_172' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_5_172_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_5_172_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Assinatura clara' ><\/div><input type='hidden' id='input_5_172_data' name='input_5_172_data' value=''><\/div><\/div><div id=\"field_5_173\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_173'>Data<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_173' id='input_5_173' type='text' value='04\/06\/2026' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/aaaa' aria-describedby=\"input_5_173_date_format gfield_description_5_173\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_173_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_173' class='gform_hidden' value='https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_5_173'>Formato: mm\/dd\/aaaa<\/div><\/div><div id=\"field_5_47\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full please-section gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>Por favor, preencha este formul\u00e1rio na \u00edntegra. As informa\u00e7\u00f5es ser\u00e3o utilizadas para avaliarmos nossa capacidade de lhe ajudar.<\/p><\/div><div id=\"field_5_49\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_49'>Por favor, explique: qual o valor espec\u00edfico necess\u00e1rio? Por que voc\u00ea precisa de ajuda? Liste todas as outras fontes de assist\u00eancia, como seguros e programas militares, \u00e0s quais voc\u00ea j\u00e1 se candidatou. Anexe documentos adicionais, se necess\u00e1rio.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_49' id='input_5_49' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_5_50\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-half mfa-form-list-left gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p><b>Exemplos de despesas eleg\u00edveis:<\/b><\/p>\n<ul>\n<li>Despesas dom\u00e9sticas: Hipoteca, aluguel e alguns reparos na resid\u00eancia principal.<\/li>\n<li>Servi\u00e7os p\u00fablicos: eletricidade, g\u00e1s, \u00e1gua, esgoto e coleta de lixo.<\/li>\n<li>Despesas com o ve\u00edculo: Pagamentos, seguro e alguns reparos importantes.<\/li>\n<li>Alimentos e vestu\u00e1rio<\/li>\n<li>Algumas despesas m\u00e9dicas podem ser consideradas.<\/li>\n<li>Despesas consideradas necessidades b\u00e1sicas da vida que causam dificuldades financeiras excessivas.<\/li>\n<\/ul><\/div><div id=\"field_5_51\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-half mfa-form-list-right gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p><b>Exemplos de despesas N\u00c3O eleg\u00edveis:<\/b><\/p>\n<ul>\n<li>Compra ou reforma de im\u00f3veis<\/li>\n<li>Despesas ou reparos de im\u00f3veis para renda<\/li>\n<li>Faturas de cart\u00e3o de cr\u00e9dito ou cart\u00f5es de cr\u00e9dito militares<\/li>\n<li>Pagamento de multas ou custas judiciais.<\/li>\n<li>Financiamento de licen\u00e7as ou f\u00e9rias.<\/li>\n<li>Cabo, Internet ou Telefones Secund\u00e1rios<\/li>\n<li>Procedimentos m\u00e9dicos est\u00e9ticos ou experimentais e despesas relacionadas.<\/li>\n<li>Impostos - sobre a propriedade ou outros<\/li>\n<li>Itens n\u00e3o essenciais para as necessidades b\u00e1sicas da vida.<\/li>\n<\/ul><\/div><div id=\"field_5_52\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full blue-background gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>As despesas eleg\u00edveis e ineleg\u00edveis listadas n\u00e3o s\u00e3o exaustivas. Todas as solicita\u00e7\u00f5es s\u00e3o analisadas individualmente. O Administrador, o Comit\u00ea e o Conselho do MFA reservam-se o direito de abrir exce\u00e7\u00f5es caso a caso. Cada solicita\u00e7\u00e3o ser\u00e1 cuidadosamente avaliada quanto aos seus m\u00e9ritos.<\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_134' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Anterior'  \/> <input type='button' id='gform_next_button_5_134' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Pr\u00f3ximo'  \/> <button type='button'  id='gform_save_5_4_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> SALVAR E CONTINUAR MAIS TARDE<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_4' class='gform_page' data-js='page-field-id-134' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_142\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><div class='gsection_description' id='gfield_description_5_142'>Liste todas as op\u00e7\u00f5es que se aplicam. <br\/> <br\/>\n<strong>Importante:<\/strong> Deve incluir TODA a renda mensal recorrente de TODOS os membros da fam\u00edlia (veterano\/militar, c\u00f4njuge, etc.). Inclua comprovante de renda; por exemplo, os dois \u00faltimos contracheques, a carta de concess\u00e3o de benef\u00edcios do Departamento de Assuntos de Veteranos (VA) mais recente, a carta de benef\u00edcios da Previd\u00eancia Social do ano vigente, etc.<\/div><\/div><div id=\"field_5_160\" class=\"gfield gfield--type-section gfield--input-type-section gsection h4-style field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Rendimento Mensal ($)<\/h3><\/div><div id=\"field_5_59\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half number-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_59'>Veterano<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_59' id='input_5_59' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_59\" \/><div class='gfield_description instruction' id='gfield_instruction_5_59'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_5_157\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-half number-field field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais<\/legend><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_157_cell1 gform-grid-col' ><input aria-invalid='false'  aria-describedby=\"gfield_description_5_157\" aria-label='C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais, Linha 1' data-aria-label-template='Spouse\/Household Members 18+, Row {0}' type='text' name='input_157[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item' aria-label='Adicione outra linha' onclick='gformAddListItem(this, 0)'>Adicionar<\/button>   <button type='button'  class='delete_list_item' aria-label='Remover a linha 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remover<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_157'>Se aplic\u00e1vel<\/div><\/fieldset><div id=\"field_5_161\" class=\"gfield gfield--type-section gfield--input-type-section gsection h4-style field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Sal\u00e1rio militar mensal ($) (se aplic\u00e1vel)<\/h3><\/div><div id=\"field_5_62\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half number-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_62'>Veterano<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_62' id='input_5_62' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_62\" \/><div class='gfield_description instruction' id='gfield_instruction_5_62'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_5_156\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-half number-field field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais<\/legend><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_156_cell1 gform-grid-col' ><input aria-invalid='false'  aria-describedby=\"gfield_description_5_156\" aria-label='C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais, Linha 1' data-aria-label-template='Spouse\/Household Members 18+, Row {0}' type='text' name='input_156[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item' aria-label='Adicione outra linha' onclick='gformAddListItem(this, 0)'>Adicionar<\/button>   <button type='button'  class='delete_list_item' aria-label='Remover a linha 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remover<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_156'>Se aplic\u00e1vel<\/div><\/fieldset><div id=\"field_5_162\" class=\"gfield gfield--type-section gfield--input-type-section gsection h4-style field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Renda\/Invalidez da Previd\u00eancia Social ($)<\/h3><\/div><div id=\"field_5_65\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half number-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_65'>Veterano<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_65' id='input_5_65' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_65\" \/><div class='gfield_description instruction' id='gfield_instruction_5_65'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_5_155\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-half number-field field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais<\/legend><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_155_cell1 gform-grid-col' ><input aria-invalid='false'  aria-describedby=\"gfield_description_5_155\" aria-label='C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais, Linha 1' data-aria-label-template='Spouse\/Household Members 18+, Row {0}' type='text' name='input_155[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item' aria-label='Adicione outra linha' onclick='gformAddListItem(this, 0)'>Adicionar<\/button>   <button type='button'  class='delete_list_item' aria-label='Remover a linha 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remover<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_155'>Se aplic\u00e1vel<\/div><\/fieldset><div id=\"field_5_163\" class=\"gfield gfield--type-section gfield--input-type-section gsection h4-style field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Pens\u00e3o do VA ou outros benef\u00edcios do VA ($)<\/h3><\/div><div id=\"field_5_68\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half number-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_68'>Veterano<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_68' id='input_5_68' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_68\" \/><div class='gfield_description instruction' id='gfield_instruction_5_68'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_5_154\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-half number-field field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais<\/legend><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_154_cell1 gform-grid-col' ><input aria-invalid='false'  aria-describedby=\"gfield_description_5_154\" aria-label='C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais, Linha 1' data-aria-label-template='Spouse\/Household Members 18+, Row {0}' type='text' name='input_154[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item' aria-label='Adicione outra linha' onclick='gformAddListItem(this, 0)'>Adicionar<\/button>   <button type='button'  class='delete_list_item' aria-label='Remover a linha 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remover<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_154'>Se aplic\u00e1vel<\/div><\/fieldset><div id=\"field_5_164\" class=\"gfield gfield--type-section gfield--input-type-section gsection h4-style field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Renda de aposentadoria ($)<\/h3><\/div><div id=\"field_5_71\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half number-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_71'>Veterano<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_71' id='input_5_71' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_71\" \/><div class='gfield_description instruction' id='gfield_instruction_5_71'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_5_153\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-half number-field field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais<\/legend><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_153_cell1 gform-grid-col' ><input aria-invalid='false'  aria-describedby=\"gfield_description_5_153\" aria-label='C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais, Linha 1' data-aria-label-template='Spouse\/Household Members 18+, Row {0}' type='text' name='input_153[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item' aria-label='Adicione outra linha' onclick='gformAddListItem(this, 0)'>Adicionar<\/button>   <button type='button'  class='delete_list_item' aria-label='Remover a linha 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remover<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_153'>Se aplic\u00e1vel<\/div><\/fieldset><div id=\"field_5_165\" class=\"gfield gfield--type-section gfield--input-type-section gsection h4-style field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Assist\u00eancia P\u00fablica (SNAP, etc.) ($)<\/h3><\/div><div id=\"field_5_130\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half number-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_130'>Veterano<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_130' id='input_5_130' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_130\" \/><div class='gfield_description instruction' id='gfield_instruction_5_130'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_5_151\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-half number-field field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais<\/legend><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_151_cell1 gform-grid-col' ><input aria-invalid='false'  aria-describedby=\"gfield_description_5_151\" aria-label='C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais, Linha 1' data-aria-label-template='Spouse\/Household Members 18+, Row {0}' type='text' name='input_151[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item' aria-label='Adicione outra linha' onclick='gformAddListItem(this, 0)'>Adicionar<\/button>   <button type='button'  class='delete_list_item' aria-label='Remover a linha 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remover<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_151'>Se aplic\u00e1vel<\/div><\/fieldset><div id=\"field_5_150\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_150'>Outras Rendas<\/label><div class='ginput_container ginput_container_text'><input name='input_150' id='input_5_150' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_77\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_77'>Veterano<\/label><div class='ginput_container ginput_container_number'><input name='input_77' id='input_5_77' type='text' step='any' min='0'  value='' class='large'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_77\" \/><div class='gfield_description instruction' id='gfield_instruction_5_77'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_5_152\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-third number-field field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais<\/legend><div class='ginput_container ginput_container_list ginput_list'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_152_cell1 gform-grid-col' ><input aria-invalid='false'  aria-describedby=\"gfield_description_5_152\" aria-label='C\u00f4njuge\/Membros da fam\u00edlia com 18 anos ou mais, Linha 1' data-aria-label-template='Spouse\/Household Members 18+, Row {0}' type='text' name='input_152[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item' aria-label='Adicione outra linha' onclick='gformAddListItem(this, 0)'>Adicionar<\/button>   <button type='button'  class='delete_list_item' aria-label='Remover a linha 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remover<\/button><\/div><\/div><\/div><\/div><\/div><div class='gfield_description' id='gfield_description_5_152'>Se aplic\u00e1vel<\/div><\/fieldset><div id=\"field_5_74\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full number-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_74'>Renda total familiar<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_74' id='input_5_74' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_74\" \/><div class='gfield_description instruction' id='gfield_instruction_5_74'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_135' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Anterior'  \/> <input type='button' id='gform_next_button_5_135' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Pr\u00f3ximo'  \/> <button type='button'  id='gform_save_5_5_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> SALVAR E CONTINUAR MAIS TARDE<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_5' class='gform_page' data-js='page-field-id-135' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_143\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Despesas m\u00e9dias mensais das fam\u00edlias<\/h3><\/div><div id=\"field_5_80\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_80'>Hipoteca\/Aluguel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_80' id='input_5_80' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_80\" \/><div class='gfield_description instruction' id='gfield_instruction_5_80'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_81\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_81'>Eletricidade \/ G\u00e1s<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_81' id='input_5_81' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_81\" \/><div class='gfield_description instruction' id='gfield_instruction_5_81'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_82\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_82'>\u00c1gua, esgoto, lixo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_82' id='input_5_82' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_82\" \/><div class='gfield_description instruction' id='gfield_instruction_5_82'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_85\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_85'>Comida\/Roupas<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_85' id='input_5_85' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_85\" \/><div class='gfield_description instruction' id='gfield_instruction_5_85'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_84\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_84'>Pagamento(s) do ve\u00edculo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_84' id='input_5_84' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_84\" \/><div class='gfield_description instruction' id='gfield_instruction_5_84'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_83\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_83'>Seguro<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_83' id='input_5_83' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_83\" \/><div class='gfield_description instruction' id='gfield_instruction_5_83'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_5_158\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full assistance-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Assist\u00eancia<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Outras despesas\/despesas diversas, se aplic\u00e1vel.<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Valor, se aplic\u00e1vel<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Descri\u00e7\u00e3o<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_158_cell1 gform-grid-col' data-label='Other\/Miscellaneous Expenses, if applicable'><input aria-invalid='false' aria-required=\"true\"  aria-label='Outras despesas\/despesas diversas, se aplic\u00e1vel, Linha 1' data-aria-label-template='Other\/Miscellaneous Expenses, if applicable, Row {0}' type='text' name='input_158[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_158_cell2 gform-grid-col' data-label='Amount, if applicable'><input aria-invalid='false' aria-required=\"true\"  aria-label='Valor, se aplic\u00e1vel, Linha 1' data-aria-label-template='Amount, if applicable, Row {0}' type='text' name='input_158[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_158_cell3 gform-grid-col' data-label='Description'><input aria-invalid='false' aria-required=\"true\"  aria-label='Descri\u00e7\u00e3o, Linha 1' data-aria-label-template='Description, Row {0}' type='text' name='input_158[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item' aria-label='Adicione outra linha' onclick='gformAddListItem(this, 0)'>Adicionar<\/button>   <button type='button'  class='delete_list_item' aria-label='Remover a linha 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remover<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_5_88\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full number-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_88'>Despesas totais da fam\u00edlia<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_88' id='input_5_88' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_88\" \/><div class='gfield_description instruction' id='gfield_instruction_5_88'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_136' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Anterior'  \/> <input type='button' id='gform_next_button_5_136' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Pr\u00f3ximo'  \/> <button type='button'  id='gform_save_5_6_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> SALVAR E CONTINUAR MAIS TARDE<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_6' class='gform_page' data-js='page-field-id-136' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_144\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Despesas e valor solicitado<\/h3><div class='gsection_description' id='gfield_description_5_144'>Liste os valores totais devidos para cada uma das contas para as quais voc\u00ea est\u00e1 solicitando ajuda para pagar. \u00c9 necess\u00e1rio apresentar documenta\u00e7\u00e3o que comprove os valores espec\u00edficos solicitados. A documenta\u00e7\u00e3o inclui, entre outros: c\u00f3pias de contratos de hipoteca\/loca\u00e7\u00e3o, contas, faturas\/recibos, or\u00e7amentos de reparos, avisos de cancelamento, avisos de despejo\/execu\u00e7\u00e3o hipotec\u00e1ria\/retomada de posse ou quaisquer outros documentos similares. Os valores solicitados n\u00e3o ser\u00e3o considerados sem TODA a documenta\u00e7\u00e3o comprobat\u00f3ria necess\u00e1ria.<\/div><\/div><div id=\"field_5_91\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_91'>Hipoteca\/Aluguel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_91' id='input_5_91' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_91\" \/><div class='gfield_description instruction' id='gfield_instruction_5_91'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_92\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_92'>Servi\u00e7os p\u00fablicos: Eletricidade<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_92' id='input_5_92' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_92\" \/><div class='gfield_description instruction' id='gfield_instruction_5_92'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_93\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_93'>Servi\u00e7os p\u00fablicos: \u00c1gua, Esgoto, Coleta de lixo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_93' id='input_5_93' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_93\" \/><div class='gfield_description instruction' id='gfield_instruction_5_93'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_103\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_5_103'>Extrato da hipoteca; ou informa\u00e7\u00f5es completas sobre o contrato de loca\u00e7\u00e3o e o propriet\u00e1rio.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_103' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_103&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_103&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_103&quot;,&quot;filelist&quot;:&quot;gform_preview_5_103&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:103,&quot;_gform_file_upload_nonce_5_103&quot;:&quot;91ae42fb3e&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_103&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_103' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Solte os arquivos aqui ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_103' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_103\"  >Selecionar arquivos<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_103'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_103'><\/ul> <div id='gform_preview_5_103' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_5_104\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_5_104'>Conta de servi\u00e7os p\u00fablicos mais recente\/atual<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_104' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_104&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_104&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_104&quot;,&quot;filelist&quot;:&quot;gform_preview_5_104&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:104,&quot;_gform_file_upload_nonce_5_104&quot;:&quot;c501304c7b&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_104&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_104' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Solte os arquivos aqui ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_104' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_104\"  >Selecionar arquivos<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_104'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_104'><\/ul> <div id='gform_preview_5_104' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_5_105\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_5_105'>Conta de servi\u00e7os p\u00fablicos mais recente\/atual<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_105' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_105&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_105&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_105&quot;,&quot;filelist&quot;:&quot;gform_preview_5_105&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:105,&quot;_gform_file_upload_nonce_5_105&quot;:&quot;8749a4c6b2&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_105&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_105' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Solte os arquivos aqui ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_105' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_105\"  >Selecionar arquivos<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_105'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_105'><\/ul> <div id='gform_preview_5_105' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_5_96\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_96'>Servi\u00e7os p\u00fablicos: G\u00e1s<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_96' id='input_5_96' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_96\" \/><div class='gfield_description instruction' id='gfield_instruction_5_96'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_95\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_95'>Pagamento de ve\u00edculo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_95' id='input_5_95' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_95\" \/><div class='gfield_description instruction' id='gfield_instruction_5_95'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_94\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_94'>Seguro<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_94' id='input_5_94' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_94\" \/><div class='gfield_description instruction' id='gfield_instruction_5_94'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_106\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_5_106'>Conta de servi\u00e7os p\u00fablicos mais recente\/atual<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_106' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_106&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_106&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_106&quot;,&quot;filelist&quot;:&quot;gform_preview_5_106&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:106,&quot;_gform_file_upload_nonce_5_106&quot;:&quot;514c458b01&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_106&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_106' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Solte os arquivos aqui ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_106' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_106\"  >Selecionar arquivos<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_106'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_106'><\/ul> <div id='gform_preview_5_106' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_5_108\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_5_108'>Declara\u00e7\u00e3o mais recente\/atual<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_108' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_108&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_108&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_108&quot;,&quot;filelist&quot;:&quot;gform_preview_5_108&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:108,&quot;_gform_file_upload_nonce_5_108&quot;:&quot;c30b2ef12c&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_108&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_108' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Solte os arquivos aqui ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_108' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_108\"  >Selecionar arquivos<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_108'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_108'><\/ul> <div id='gform_preview_5_108' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_5_107\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_5_107'>Declara\u00e7\u00e3o mais recente\/atual<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_107' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_107&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_107&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_107&quot;,&quot;filelist&quot;:&quot;gform_preview_5_107&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:107,&quot;_gform_file_upload_nonce_5_107&quot;:&quot;81cbfc3289&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_107&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_107' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Solte os arquivos aqui ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_107' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_107\"  >Selecionar arquivos<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_107'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_107'><\/ul> <div id='gform_preview_5_107' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_5_97\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_97'>Despesas m\u00e9dicas<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_97' id='input_5_97' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_97\" \/><div class='gfield_description instruction' id='gfield_instruction_5_97'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_98\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_98'>Reparo: Dom\u00e9stico ou de Ve\u00edculo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_98' id='input_5_98' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_98\" \/><div class='gfield_description instruction' id='gfield_instruction_5_98'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><div id=\"field_5_109\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_5_109'>Fatura mais recente\/atual<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_109' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_109&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_109&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_109&quot;,&quot;filelist&quot;:&quot;gform_preview_5_109&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:109,&quot;_gform_file_upload_nonce_5_109&quot;:&quot;75ac659828&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_109&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_109' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Solte os arquivos aqui ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_109' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_109\"  >Selecionar arquivos<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_109'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_109'><\/ul> <div id='gform_preview_5_109' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_5_110\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_5_110'>Or\u00e7amento ou fatura de reparo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_110' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_110&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_110&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_110&quot;,&quot;filelist&quot;:&quot;gform_preview_5_110&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:110,&quot;_gform_file_upload_nonce_5_110&quot;:&quot;682d4f23f7&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_110&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_110' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Solte os arquivos aqui ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_110' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_110\"  >Selecionar arquivos<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_110'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_110'><\/ul> <div id='gform_preview_5_110' class='ginput_preview_list'><\/div><\/div><\/div><fieldset id=\"field_5_159\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full assistance-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Outras despesas\/despesas diversas<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Outras despesas\/despesas diversas, se aplic\u00e1vel.<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Valor, se aplic\u00e1vel<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Descri\u00e7\u00e3o<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_159_cell1 gform-grid-col' data-label='Other\/Miscellaneous Expenses, if applicable'><input aria-invalid='false' aria-required=\"true\"  aria-label='Outras despesas\/despesas diversas, se aplic\u00e1vel, Linha 1' data-aria-label-template='Other\/Miscellaneous Expenses, if applicable, Row {0}' type='text' name='input_159[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_159_cell2 gform-grid-col' data-label='Amount, if applicable'><input aria-invalid='false' aria-required=\"true\"  aria-label='Valor, se aplic\u00e1vel, Linha 1' data-aria-label-template='Amount, if applicable, Row {0}' type='text' name='input_159[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_159_cell3 gform-grid-col' data-label='Description'><input aria-invalid='false' aria-required=\"true\"  aria-label='Descri\u00e7\u00e3o, Linha 1' data-aria-label-template='Description, Row {0}' type='text' name='input_159[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item' aria-label='Adicione outra linha' onclick='gformAddListItem(this, 0)'>Adicionar<\/button>   <button type='button'  class='delete_list_item' aria-label='Remover a linha 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remover<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_5_101\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_5_101'>Outro<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_101' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_101&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_101&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_101&quot;,&quot;filelist&quot;:&quot;gform_preview_5_101&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/?gf_page=3e476ed529d9fa4&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/vetaffairs.la.gov\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;134217728b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:101,&quot;_gform_file_upload_nonce_5_101&quot;:&quot;be59ce0ac6&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_101&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_101' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Solte os arquivos aqui ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_101' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_101\"  >Selecionar arquivos<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_101'>Tamanho m\u00e1ximo do arquivo: 128 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_101'><\/ul> <div id='gform_preview_5_101' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_5_102\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_102'>Valor total solicitado (Deve ser um valor espec\u00edfico comprovado por documenta\u00e7\u00e3o, anexada acima)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_102' id='input_5_102' type='text' step='any' min='0'  value='' class='large'    placeholder='Quantia' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_5_102\" \/><div class='gfield_description instruction' id='gfield_instruction_5_102'>Por favor, insira um n\u00famero maior ou igual a <strong>0<\/strong>.<\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_5_137' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Anterior'  \/> <input type='button' id='gform_next_button_5_137' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Pr\u00f3ximo'  \/> <button type='button'  id='gform_save_5_7_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> SALVAR E CONTINUAR MAIS TARDE<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_5_7' class='gform_page' data-js='page-field-id-137' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_5_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_5_145\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Outras formas de assist\u00eancia solicitadas antes de recorrer ao Fundo do Minist\u00e9rio das Rela\u00e7\u00f5es Exteriores<\/h3><\/div><fieldset id=\"field_5_115\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full assistance-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Assist\u00eancia<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Fonte<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Data de aplica\u00e7\u00e3o<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Status<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Valor Solicitado<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_115_cell1 gform-grid-col' data-label='Source'><input aria-invalid='false' aria-required=\"true\"  aria-label='Fonte, Linha 1' data-aria-label-template='Source, Row {0}' type='text' name='input_115[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_115_cell2 gform-grid-col' data-label='Date Applied'><input aria-invalid='false' aria-required=\"true\"  aria-label='Data de aplica\u00e7\u00e3o, Linha 1' data-aria-label-template='Date Applied, Row {0}' type='text' name='input_115[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_115_cell3 gform-grid-col' data-label='Status'><input aria-invalid='false' aria-required=\"true\"  aria-label='Status, Linha 1' data-aria-label-template='Status, Row {0}' type='text' name='input_115[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_115_cell4 gform-grid-col' data-label='Amount Requested'><input aria-invalid='false' aria-required=\"true\"  aria-label='Valor solicitado, Linha 1' data-aria-label-template='Amount Requested, Row {0}' type='text' name='input_115[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item' aria-label='Adicione outra linha' onclick='gformAddListItem(this, 0)'>Adicionar<\/button>   <button type='button'  class='delete_list_item' aria-label='Remover a linha 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remover<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_5_146\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><div class='gsection_description' id='gfield_description_5_146'>Eu, [nome], certifico que as informa\u00e7\u00f5es fornecidas neste formul\u00e1rio s\u00e3o verdadeiras e corretas. Com minha assinatura, autorizo a divulga\u00e7\u00e3o das informa\u00e7\u00f5es de privacidade ao Departamento de Assuntos de Veteranos da Louisiana (LDVA) para fins de verifica\u00e7\u00e3o. Autorizo o acesso do Departamento de Assuntos de Veteranos da Louisiana aos meus registros pertinentes, incluindo informa\u00e7\u00f5es mantidas no DEERS, ou outras informa\u00e7\u00f5es de privacidade, para fins de verifica\u00e7\u00e3o. Compreendo que a falta de informa\u00e7\u00f5es completas e\/ou documenta\u00e7\u00e3o comprobat\u00f3ria impedir\u00e1 o processamento do meu pedido de autoriza\u00e7\u00e3o para o pagamento de aux\u00edlio financeiro (MFA). <br\/> <br\/>\nCaso seja eleg\u00edvel para receber os fundos, certifico que estes ser\u00e3o utilizados para os fins indicados em minha solicita\u00e7\u00e3o. Compreendo que, se minha solicita\u00e7\u00e3o for aprovada, a assist\u00eancia ser\u00e1, na maioria dos casos, paga diretamente ao prestador de servi\u00e7os e n\u00e3o a mim. Comprometo-me a reembolsar o MFA Fund caso receba pagamentos de outra fonte especificamente para atender \u00e0 necessidade para a qual estou solicitando assist\u00eancia do MFA. Compreendo que fornecer informa\u00e7\u00f5es falsas nesta solicita\u00e7\u00e3o, de forma intencional e consciente, poder\u00e1 resultar na sua recusa.<\/div><\/div><div id=\"field_5_118\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_118'>Assinatura do candidato<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_5_118_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><input type='hidden' class='gform_hidden' name='input_5_118_valid' id='input_5_118_valid' \/><canvas id='input_5_118' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_5_118_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_5_118_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Assinatura clara' ><\/div><input type='hidden' id='input_5_118_data' name='input_5_118_data' value=''><\/div><\/div><div id=\"field_5_119\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_5_119'>Data<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obrigat\u00f3rio)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_119' id='input_5_119' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/aaaa' aria-describedby=\"input_5_119_date_format gfield_description_5_119\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_119_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_119' class='gform_hidden' value='https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_5_119'>Formato: mm\/dd\/aaaa<\/div><\/div><div id=\"field_5_121\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full mfa-form-notice-block mfa-form-notice-block-center blue-background gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p><b>\u00c9 NECESS\u00c1RIO apresentar c\u00f3pias dos seguintes documentos:<\/b><\/p>\n<ul>\n<li>C\u00f3pia do DD214 ou da Certid\u00e3o de Dispensa do Veterano\n<\/li>\n<li>Comprova\u00e7\u00e3o de parentesco com veterano ou membro das for\u00e7as armadas eleg\u00edvel para familiares imediatos que estejam solicitando o benef\u00edcio em nome do veterano. (C\u00f3pia da certid\u00e3o de casamento, certid\u00e3o de nascimento, DEERS ou procura\u00e7\u00e3o).\n<\/li>\n<li>C\u00f3pia de um documento de identidade com foto v\u00e1lido ou documento de identidade militar\/DEP.\n<\/li>\n<li>Comprovante de resid\u00eancia atual na Louisiana\n<\/li>\n<li>Comprovante de rendimentos\/licen\u00e7a atual ou comprovante da renda mensal total familiar.\n<\/li>\n<li>Extratos atuais de contas, aluguel\/hipoteca e avisos de execu\u00e7\u00e3o hipotec\u00e1ria, despejo e corte de servi\u00e7os para os quais voc\u00ea precisa de ajuda.\n<\/li>\n<li>Or\u00e7amentos para reparos ou outras finalidades, caso precise de assist\u00eancia com reparos\/substitui\u00e7\u00f5es.\n<\/li>\n<li>Militares da Guarda Nacional, da Reserva ou da ativa DEVEM fornecer uma c\u00f3pia da ordem militar, caso a ativa\u00e7\u00e3o cause dificuldades.\n<\/li>\n<\/ul>\n<p><\/p>\n<p>O Fundo de Assist\u00eancia \u00e0s Fam\u00edlias Militares \u00e9 um fundo de \u00faltimo recurso. Todos os candidatos devem buscar aux\u00edlio em outras fontes dispon\u00edveis antes de se inscreverem no Programa de Assist\u00eancia \u00e0s Fam\u00edlias Militares. Todos os candidatos devem apresentar comprovantes de solicita\u00e7\u00f5es feitas a outras fontes e informar os valores recebidos.\n<\/p>\n<p>Todos os candidatos dever\u00e3o fornecer a documenta\u00e7\u00e3o exigida, listada acima, bem como qualquer documenta\u00e7\u00e3o adicional que possa ser solicitada pelo Administrador, Comit\u00ea ou Conselho do MFA. A n\u00e3o apresenta\u00e7\u00e3o dessas informa\u00e7\u00f5es dentro do prazo estipulado poder\u00e1 resultar na recusa da candidatura.<\/p>\n<p>A candidatura enviada por correio deve conter as ASSINATURAS ORIGINAIS DO CANDIDATO, quando solicitadas.<\/p>\n<p>Favor enviar o formul\u00e1rio de inscri\u00e7\u00e3o preenchido, juntamente com toda a documenta\u00e7\u00e3o comprobat\u00f3ria NECESS\u00c1RIA, para o seguinte endere\u00e7o:<\/p>\n<p>Departamentos de Assuntos de Veteranos da Louisiana<br>A\/C: Administrador de MFA<br>Caixa Postal 94095<br>Baton Rouge, Louisiana 70804-9095<\/p><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_5' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Anterior'  \/> <input type='submit' id='gform_submit_button_5' class='gform_button button' 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