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PERM22-tt (AC) 4/17/2020
2. STATEMENT OF ESTIMATED 2020 INCOME
Estimate your family income for the entire year (January 1, 2020 to December 31, 2020) by indicating the annual
amounts in each space below. If the question does not apply to you, indicate ‘0’ - do not leave any lines blank.
This form will be returned to you if it is incomplete, and this will delay the processing of your financial aid.
If the student is Dependent, list parent(s) and/or student’s information.
If the student is Independent, list student’s and/or spouse’s (if applicable) information.
Dependent Student’s Dependent or Independent
Parent(s) Information &/OR Student/Spouse’s Information
A.
E
xpected 2020 Taxable Income
1. Wages, Salaries, Tips Father $ Student $
Mother $ Spouse $
2. Pension & Annuities $ $
3. Interest/Dividend Income $ $
4. Business or Farm Income $ $
5. Capital Gains $ $
6. Rents Which Will Be Received $ $
7. Alimony $ $
8. Unemployment Compensation $ $
9. Other Taxed Income, $ $
Explain:
B. Expected 2020 Untaxed Income & Benefits
1. Social Security $ $
2. Public Assistance $ $
3. Child Support $ $
4. Housing Allowance $ $
5. Retirement or Disability Benefits $ $
6. Worker's Compensation $ $
7. Payments to Tax-Deferred Pensions $ $
& Savings Plans (Paid directly or withheld
f
rom earnings - include 401K & 403B plans)
8. Untaxed Portion of Pension $ $
9. Other Untaxed Income, $ $
Explain:
Total: $ Total: $
3. SIGNATURE(S)
By signing below, I/We certify that the above information is true and correct to the best of my/our knowledge:
Student Signature Date Student Daytime Phone Number
If Dependent, Parent Signature Date If Independent & Applicable, Spouse’s Signature Date
Ensure that Sections 1 and 2, are complete and that all of the required supporting documentation is attached
and return this form in person, via mail, fax, or email to finaid@mymail.lccc.edu
at your earliest convenience.
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