2019-2020
Certification of Non-Tax Filing
I,
_________________________________, by signing below, am certifying the following:
• I did not file taxes for 2017.
• I was not required by law to file a 2017 tax return with the Internal Revenue Service (IRS).
• If I earned income, all income sources and amounts are listed on the Verification Worksheet and are listed
below on this form.
• I have provided all corresponding 2017 W-2 statements or equivalent (such as IRS Wage and Income Statement)
to the college.
• I attempted to obtain Verification of Nonfiling from the IRS (or foreign tax authority
if applicable) but was unable to obtain the required documentation.
Sources of EARNED Income for 2017:
Name of Employer_________________________________ Gross Amount Earned: ____________
Name of Employer_________________________________ Gross Amount Earned: ____________
Name of Employer_________________________________ Gross Amount Earned: ____________
Name of Employer_________________________________ Gross Amount Earned: ____________
Name of Employer_________________________________ Gross Amount Earned: ____________
**If you have additional employers/amounts earned, please submit them on a separate sheet of paper.
I certify that I understand that the Secretary of Education has the authority to verify information reported on my
application (or my child’s or my spouse’s application) with the Internal Revenue Service and other federal agencies. If
I purposely give false or misleading information, I may be fined up to $20,000, imprisoned, or both.
Sig
nature: _________________________________ Date: ____________
Student ID/SSN: _____________________________
