York County Community College
STATEMENT OF NON-FILING STATUS
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_____________________________ |
_______________________________ |
Student Name Social Security Number
If you or your parent(s) did not file and are not required to file a 20__ Federal income, check all the boxes that apply.
a. I (we) did not file and are not required to file a 20__ Federal income tax return.
A. EARNED INCOME
List your and your parent(s)' employer(s) and any income received from work in 20__ (from W-2s or other earnings statements). If NO income was received in 20__ or if income was from financial aid, write "NONE".
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Employer |
Amount |
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Student |
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$ |
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Spouse |
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$ |
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Mother/Stepmother |
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$ |
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Father/Stepfather |
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$ |
B. UNTAXED INCOME
List the amounts of income received in 20__ in each category listed below. Write in the total received in 20__, not weekly or monthly amounts. If no income was received in a particular category, write "NONE"
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Type of Income |
Rec'd by Student in 20__ |
Rec'd by Parent(s) in 20__ |
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Child Support |
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$ |
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Welfare Benefits/TANF |
$ |
$ |
|
Social Security Benefits |
$ |
$ |
|
Worker's Comp |
$ |
$ |
|
Contributions to retirement plans 401(k), 403(b) from W-2 Forms |
$ |
$ |
|
Other Untaxed Income |
$ |
$ |
C. CERTIFICATION
By Signing this form, I certify that all of the information reported to qualify for Federal student financial aid is complete and correct. WARNING: If you purposely give false or misleading information on this form, you may be fined, sentenced to jail, or both.
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__________________________________ |
___________________________________ |
Student's Signature Date Mother's/Stepmother's Signature Date
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__________________________________ |
___________________________________ |
Spouse's Signature Date Father's/Stepfather's Signature Date
RETURN THIS FORM TO:
York County Community College
FINANCIAL AID OFFICE
112 COLLEGE DRIVE
WELLS, ME 04090