Fillable LBWCC IC INDEPENDENT STUDENT PROOF OF INCOME AND (Lurleen B Wallace Community College)

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LBWCC IC INDEPENDENT STUDENT PROOF OF INCOME AND (Lurleen B Wallace Community College)

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Revised 11/23/2020
LBWCC – IC
INDEPENDENT STUDENT PROOF OF INCOME
AND DECLARATION THAT A 2019
FEDERAL
INCOME TAX RETURN WAS NOT FILED and
DOCUMENTATION THAT YOU SUPPORT YOUR
CHILD.
Student Name_________________________________ Student Number:_____________________
List below all sources of income for 2019 and attach documentation of that income.
Student: You reported on your FAFSA that your income or financial resources for 2019 was less than the amount
required to file an income tax return as stated in 2019 IRS Publication 17, (additional guidelines on back) and that
your currently have a child that you support.
Source
Amount
Student
2019
Income
Current
Income
(Anticipated)
Earnings
$
$
Social Security Benefits
Child Support
AFDC/Welfare
Housing, food, and other
living allowances (excluding
Rent subsidies for low income
housing)
Food Stamps
Other
Provide documentation, including but not limited to, current paystubs documenting your ability to support
yourself and your child.
Or if you have other unusual circumstances, you must explain how you financially survived in the 2019 calendar
year on the resources reported on your FAFSA.
Please state your unusual circumstances, if any:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Did you or any one in your household receive any of the following for 2019 or 2020: food stamps? _____
Subsidized Housing? _____ if yes, how much $___________ Subsidized utilities? If yes, how much $__________
Rental Allowance? _____, if yes, how much $___________ ; Medicaid? ________
Revised 11/23/2020
LBWCC-IC
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
.
Please complete reverse side.
According to 2019 IRS Publication 17, (go to www.irs.gov
- Publication 17, Table 1-1 for more information):
2019 Filing Requirements for Most Taxpayers:
IF your filing Status is AND at the end of 2019 you were…
THEN file a return if your income
was at least...
Single
Under 65
$12,200
65 or older
$13,850
Married filing jointly
Under 65 (both spouses)
$24,400
65 or older (one spouse)
$25,700
65 or older (both spouses)
$27,000
Married filing separately
Any age
$5
Head of household
Under 65
$18,350
65 or older
$20,000
Qualifying widow(er) with dependent
child
Under 65
$24,400
65 or older
$25,700
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 2019 Federal Income Tax Return.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or
both.
_______________________________________
Student 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 you did not file a 2019 Federal Tax Return
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LBWCC IC INDEPENDENT STUDENT PROOF OF INCOME AND (Lurleen B Wallace Community College)

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Completed 2 February 2021

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