06/28/19
2019-2020
LOW INCOME STATEMENT/with UNTAXABLE INCOME
I will not file, and was not required to file, a 2017 IRS form 1040/1040A or
1040EZ tax return. I did not receive any taxable income during 2017.
I will not file, and was not required to file, a 2017 IRS form 1040/1040A or
1040EZ tax return. I did receive taxable income during 2017 from the
following sources and will provide the Financial Aid Office with a copy of
the W-2 or earning statement:
I certify that all the financial aid information reported on the student’s 2019-
2020 Free Application for Federal Student Aid (FAFSA) is true and
complete to the best of my knowledge.
I have attempted to obtain a 4506-T letter/transcript and/or verification from
the IRS verifying my non-filing status. However, I have been unable to
obtain the required documentation. As soon as I receive this verification, it
will be submitted to the J Sargeant Reynolds Financial Aid office.
______________________________________ ____________________
Student Signature Date
______________________________________ ____________________
Spouse Signature Date
Student Name: _______________________ STUD ID#: ___________
Please note: Further documentation may be required, i.e. proof of separate domiciles; order of child
support and/or spousal support, etc.
As per the United States Department of Education, “If you purposely give false or misleading information,
you may be fined $20,000, sent to prison, or both.”
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