Zero Income Verification

Please complete this form to attest that you currently have zero income from the sources listed below.

I DO HEREBY SWEAR AND ATTEST THAT I CURRENTLY HAVE ZERO INCOME AND THAT I DO NOT RECEIVE INCOME FROM THE FOLLOWING SOURCES:

  1. Wages from any type of employment (including commission and fees)
  2. Self-Employment Income (operation of a business, Avon, Mary Kay, etc.)
  3. Regular monthly cash gifts, contributions from outside sources
  4. Alimony or child support income
  5. Interest or dividends from assets
  6. Loans (not educational)
  7. Lawsuit/lump-sum payments, mineral rights
  8. Pension/annuities
  9. Social Security payments
  10. Unemployment payments
  11. VA payments
  12. Worker’s compensation