(Use this form only if you have no income)
Documentation of No Family Income
I, __________________________________ being aware of the financial situation of ________________________________
(Full name of person providing information) (Parent/Guardian Name of Child Applying)
Do hereby attest that this family does not have any source of income known to me at this point and time.
In addition, I provide the following for the family due to their inadequate economic status:
I do not provide any type of support, I just am aware of their financial situation.
I provide room and board for this family
I only provide housing for this family
I provide financial support for this family in the amount of $ ______________
Printed name of person providing information: ________________________________________________________________
Mailing Address ________________________________________________________________________________________
Phone Number __________________________________ Date Signed __________________________________
Signature: ____________________________________________________________________________________________
I agree that the above information is correct.
Signature of Parent applying child: ________________________________________________________________________
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