2019-2020 Student Income Verification 19SIVER
To request a copy of a *Federal IRS Tax Return Transcript, Wage Statement, OR Verification of Non-Filing Letter call the
IRS at 1-800-908-9946, go to http://www.irs.gov/individuals/Order-a-Transcript or use a 4506T form https://www.irs.gov/pub/irs-pdf/f4506t.pdf
2017 Income Information for Tax Filers – Check the box that applies
Student/Spouse (if married)
I/we filed a 2017 Federal Tax Return
Attach a copy of student/spouse (if married) 2017 IRS Tax Return Transcript*
Student married/remarried after the 2017 tax year
Attach a copy of the 2017 IRS Tax Return Transcript* for the one who FILED and complete
the Non-Tax Filers section below for the one who did not file a tax return
I/we filed an amended 2017 IRS tax return
Attach a copy of both a 2017 IRS Tax Return Transcript* and a signed copy of the 2017 IRS
Form 1040X “Amended US Individual Tax Return” that was filed with the IRS
2017 Income Information for Non-Tax Filers – Check the box that applies
Student/Spouse (if married)
Student and/or spouse (if married) were employed in
2017 but not required to file a tax return
Complete the chart below. Attach copies of all W-2s* and a 2017 IRS Verification of Non-
filing* status letter dated on or after October 1, 2018 for non-filer(s). Note: If you are a
Dependent student, the IRS Verification of Non-filing is NOT required.
Neither student and spouse (if married) were employed
and neither had income earned from work in 2017
Attach a 2017 IRS Verification of Non-filing* status letter dated on or after October 1, 2018
for non-filer(s). Note: If you are a Dependent student, this document is NOT required.
Susy’s Auto Body Shop (example)
$
$
$
Student/spouse (if married) received the following benefits in 2017 as part of their financial support:
Supplemental Security Income (SSI) Social Security Benefits
Other ________________________________________________
Asset Information
Complete this chart about the student/spouse (if married) asset information as of the date you signed the FAFSA or CA Dream Act Application.
1. Cash/checking/saving balances as of the date you signed the FAFSA or CA Dream Act Application $
2. Investment value (rental real estate, stocks) as of the date you signed the FAFSA or CA Dream Act Application $
3. Business Value as of the date you signed the FAFSA or CA Dream Act Application $
CERTIFICATION
I/WE HEREBY CERTIFY THAT ALL INFORMATION REPORTED ON THIS FORM AND ANY ATTACHMENTS HERETO ARE TRUE, COMPLETE AND
ACCURATE. FALSE INFORMATION OR MISREPRESENTATION WILL BE CAUSE FOR DENIAL, REDUCTION, WITHDRAWAL, AND/OR REPAYMENT OF
FINANCIAL AID.
________________________________________________________________ __________________________
Student’s Signature Date
________________________________________________________________ __________________________
Spouse’s Signature (Optional) Date
20
19-2020 STUDENT INCOME VERIFICATION
STUDENT INFORMATION
Please PRINT clearly with black/blue ink
SJC Financial Aid Office * 1499 N State Street * San Jacinto, CA 92583 * Telephone: (951) 487-3245
MVC Financial Aid Office * 28237 La Piedra Road * Menifee, CA 92584 * Telephone: (951) 639-5245
Email: finaid@msjc.edu * Website: www.msjc.edu
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