Student'S (Parent'S) Certification Of Non-Filing Template printable pdf download

Financial Aid Office

United States University

140 W. 16

Street

National City, CA 91950

(619) 477-6310

STUDENT’S (PARENT’S) CERTIFICATION OF NON-FILING

2010-2011 AWARD YEAR

Name of Student:

Social Security No.:

Name of Parent:

Parent’s Social Security No.:

I/we hereby certify that I/we did not and will not file a 2009 Federal Income Tax Return because (check all that apply to you):

I/we did not work during 2009.

I/we worked during 2009, but did not file a 2009 Federal Income Tax Return. I/we earned $___________ in 2009. Please see

attached copy of my 1722 from the Internal Revenue Service.

I/we earned $______________ in interest/dividend income.

I/we received other income during 2009 from sources not included in amounts above. Those sources were as

follows:________________________________________________________________________

________________________________________________________________________________________________________

_______________________________________________

I/we received non-taxable income during 2009 from the following sources:

________________________________________________________________________________________________________

_______________________________________________

6. My/our total income from all sources for 2009 was $_________________. (Total of lines 1 through 5)

Certification

I swear and affirm that the above information is true and correct to the best of my knowledge. I understand that any false statements or

misrepresentations will be cause for denial, reduction, withdrawal, and/or repayment of financial aid from federal, state, and institutional sources, and

may subject applicant to a fine or imprisonment or both, under provisions of the United States Criminal code. I also agree to provide official

confirmation of any of the above information and understand that US University may ask for an official verification of non-filing status directly from the

PLEASE SEE ATTACHED MY 1722 FORM FROM THE INTERNAL REVENUE SERVICE.

Internal Revenue Service.

Student’s Signature:

Date:

Parent’s Signature

Date: