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P0101092019
2019‐20Statement of Non-filing
Submitted in lieu of an IRS Verification of Non-filing letter by Independent students and parents of Dependent
students who did not file and are not required to fil
e a 2017 income tax return.
StudentName:_________________________________GCUStudentNumber:____________________
I hereby attest that I have attempted to obtain a "Verification of Non-filing" letter from the IRS or other
tax authorities and was unable to obtain the required documentation.
I certify that I have not filed and I am not required to file a 2017 income tax return.
I have provided on the Verification Worksheet a listing of the sources of any of my 2017 income
earned from work, the amount of income from each source, and a copy of my W-2 or equivalent
document for each source.
StudentSignature:_ _______________ ___________________ _________Date:____________________
SpouseSignature (if applicable):_________________________________Date:____________________
ParentSignature: ____________________________________________Date:____________________
(Required for Dependent Students Only)
HANDWRITTENSIGNATURESREQUIRED–TYPED/ELECTRONICSIGNATURESNOTACCEPTED
WARNING: If false or misleading information is purposely provided on this form, student and/or parent/spouse may be fined,
sent to prison, or both.
