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Parent(s)
2007 Non-tax Filers Statement
Students
Name:_____________________________________SSN:________________________
PARENTS ONLY-
DO NOT complete if filing a tax return.
I/we
have not filed and am/are not required to file a 2007 U.S. Income
Tax Return. All income information submitted to the Office of Financial
Aid, which will be used to calculate my eligibility for financial
assistance is complete and correct to the best of my/our knowledge.
Indicate
next to each of the federal benefit programs listed below that anyone in
your family (included as household member on the FAFSA) received
benefits from anytime during 2007:
___Supplemental Security Income (SSI) ___Food Stamps ___Free/Reduced
Lunch ___TANF ___WIC
My/our
total income and benefits for 2007 was/were derived from the following
sources:
|
Sources of Income/Benefits for 2007
(Do not include work-study earnings) |
Total Amounts of Income/benefits
(If “none” or “zero” enter “0” |
|
Wages, Salaries, Tips, etc (Attach copies of W2’s) |
$ |
|
Interest/Dividend Income |
$ |
|
TANF |
$ |
|
Child Support received for all children |
$ |
|
Retirement Income |
$ |
|
Social Security (include amounts received “for” children |
$ |
|
Workers’ Compensation |
$ |
|
Unemployment Compensation |
$ |
|
Welfare Benefits (except food stamps) |
$ |
|
Alimony |
$ |
|
Veteran’s Noneducation Benefits (Such as Death Pension, DIC,
etc.) |
$ |
|
Other untaxed income or benefits not reported elsewhere on this
form
Specify: |
$ |
“Current”
Marital Status:
Single_____ Married/Remarried_____ Separated/Divorced_____
Widowed_____
Certification: All of the information on this form is
true and complete to the best of my/our knowledge. If asked by an
authorized official, I/we agree to provide whatever documentation may be
necessary to verify information listed above.
Mother’s/Stepmother’s Signature________________________________________
Date_____________
Father’s/Stepfather’s
Signature__________________________________________ Date_____________
RETURN THIS FORM TO:
YCCC FINANCIAL AID OFFICE
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