Revised 10/21/19
LBWCC - ID
DEPENDENT STUDENT PROOF OF INCOME
AND DECLARATION THAT A 2018 FEDERAL
INCOME TAX RETURN WAS NOT FILED.
Student Name_________________________________ Student ID No._________________
Last First Middle
List below all sources of income for 2018 and attach documentation of that income.
St
udent: You reported on your FAFSA that your income or financial resources for 2018 was less than the amount
required to file an income tax return as stated in 2018 IRS Publication 17, (additional guidelines on back).
Source
Student Amount
Earnings
$
Social Security Benefits
Child Support
AFDC/Welfare
Housing, food, and other Living allowances (excluding Rent subsidies for low
income housing)
Food Stamps
Other
Total
$
Parent: Your dependent student reported on the FAFSA that your 2018 income or financial resources is
less than the amount required to file an income tax return as stated in as stated in 2018 IRS Publication 17,
(additional guidelines on back).
Source
Amount
Mother/Stepmother
Amount
Father/Stepfather
Total
Earnings
$
$
$
Social Security Benefits
Child Support
AFDC/Welfare
Housing, food, and other
living allowances (excluding
Rent subsidies for low income
housing)
Food Stamps
Other
Total
$
Or if you have other unusual circumstances, you must explain how you financially survived in the 2018 calendar
year on the resources reported on your FAFSA.
Please state your unusual circumstances, if any.
Please complete reverse side.
Revised 10/21/19
LBWCC - ID
Did you or any one in your household receive any of the following for 2018 or 2019: food stamps? _____
Subsidized Housing? _____ if yes, how much $___________ Subsidized utilities? If yes, how much $__________
Rental Allowance? _____, if yes, how much $___________; Medicaid? ________
Do you receive support not reported on the FAFSA such as food, clothing, or shelter from friends, relatives, a church, etc?
NOTE: Any cash provided to you or cash paid on your behalf must be reported on the FAFSA as untaxed income
.
According to 2018 IRS Publication 17, (go to www.irs.gov - Publication 17, pages 6-7 for more information):
For Dependent Student: Single dependentsmust file if any of the following apply (Table 1-2):
Your unearned income was more than $2,650 ($4,250 if 65 or older and blind).
Your earned income was more than $13,600 ($15,200 if 65 or older and blind).
Your gross income was more than the larger of: $2,650 or Your earned income (up to $11,650) plus $1,950.
According to 2018 IRS Publication 17, (go to www.irs.gov
- Publication 17, Table 1-1 for more information):
2018 Filing Requirements for Most Taxpayers: (Parents)
IF your filing Status is AND at the end of 2018 you were…
THEN file a return if your income
was at least...
Single
Under 65
$12,000
65 or older
$13,600
Married filing jointly
Under 65 (both spouses)
$24,000
65 or older (one spouse)
$25,300
65 or older (both spouses)
$26,600
Married filing separately
Any age
$5
Head of household
Under 65
$18,000
65 or older
$19,600
Qualifying widow(er) with dependent
child
Under 65
$24,000
65 or older
$25,300
By signing this worksheet, I (we) certify that all the information reported to qualify for student aid is complete
and correct and that I (we) was (were) not required to file a 2018 Federal Income Tax Return. At least one
parent must sign.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or
both.
_______________________________________ _______________________________________
Student Date Parent Date
It is the official policy of the Alabama Department of Postsecondary Education, including postsecondary institutions under the control of the State Board of Education, that no
person shall, on the grounds of race, color, handicap, gender, religion, creed, national origin, or age, be excluded from participation in, be denied the benefits of, or be subjected
to discrimination under any program, activity or employment. LBW Community College will make reasonable accommodations for qualified disabled applicants or employees
.
You must provide a statement from the IRS stating that a 2018 Federal Tax Return was not filed for you
and your parent(s).