Fillable NON-TAX FILER 2020-21 VERIFICATION OF INCOME FOR NON-TAX (Central Community College)

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NON-TAX FILER 2020-21 VERIFICATION OF INCOME FOR NON-TAX (Central Community College)

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BROWSE CENTRAL COMMUNITY COLLEGE FORMS

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2020-21 VERIFICATION OF INCOME FOR NON-TAX FILERS
Please complete this form on a computer, or use black or blue ink.
STUDENT NAME_______________________________________ CCC ID# OR LAST 4# OF SSN________________
You indicated on your FAFSA that you or someone in your household (spouse or parent) will not file and are
not required to file a 2018 federal income tax form with the IRS. That individual must complete this form. If
the non-tax filer status applies to more than one person, each non-filer will need to complete a separate form.
NON-TAX FILER
_
________________________________________________________________________________________
N
ON-TAX FILER NAME RELATIONSHIP TO STUDENT (STUDENT/SPOUSE/PARENT)
C
HECK THE BOX THAT APPLIES TO THE NON-FILING TAX PERSON:
I was not employed and had no income earned from work in 2018. I was not required to file a tax form.
I was employed in 2018 but did not file a federal income tax form. I was not required to file.
Attached are copies of my 2018 W-2 forms.
Lis
t all employer(s) even if the employer did not issue you an IRS W-2 form.
E
MPLOYER 2018 Work Income
Did you receive a
W-2 form?
Total Amount of Income Earned from Work $
CERTIFICATION
Signing below certifies that all of the information reported is complete and correct. An electronic
signature is not valid.
_
_______________________________________________________________
N
ON-FILER SIGNATURE DATE
Please return this form to the Financial Aid Office at the location you plan to attend:
Central Community College – Columbus PO Box 1027 Columbus, NE 68602-1027 Fax: 402-562-1290
Central Community College – Grand Island PO Box 4903 Grand Island, NE 68802-4903 Fax: 308-398-7407
Central Community College – Hastings PO Box 1024 Hastings NE 68902-1024 Fax: 402-461-2447
Central Community College – Kearney PO Box 310 Kearney, NE 68848-0310 Fax: 308-338-4041
PROCEED TO THE NEXT PAGE UNLESS YOU ARE A DEPENDENT STUDENT
(PARENTAL INFORMATION WAS REQUIRED ON YOUR FAFSA).
WARNING: If you purposely give
false or misleading information,
you may be fined, sent to prison,
or both.
2020-21 VERIFICATION OF INCOME FOR NON-TAX FILERS – PAGE 2
Please complete this form on a computer, or use black or blue ink.
STUDENT NAME_______________________________________ CCC ID# OR LAST 4# OF SSN________________
NON-TAX FILER
__
_______________________________________________________________________________________
N
ON-TAX FILER NAME RELATIONSHIP TO STUDENT (STUDENT/SPOUSE/PARENT)
OTHER INCOME SOURCES
THE NON-TAX FILER RECEIVED THE FOLLOWING PUBLIC ASSISTANCE (FAMILY INCLUDED, IF APPLICABLE) IN 2018 OR 2019.
ADC/AFDC VA Benefits (yearly) $____________________
Food Stamps Workman’s Compensation
Medicaid/Untaxed Social Security Benefits Other_________________________________
T
HE NON-TAX FILER WAS SUPPORTED IN 2018 BY:
Family Member Name______________________________________Relationship_________________
Friend/Significant Other Name__________________________________________________________
P
LEASE PROVIDE A BRIEF STATEMENT OF HOW THE NON-TAX FILER/NON-TAX FILER FAMILY WAS SUPPORTED.
CERTIFICATION
Signing below certifies that all of the information reported is complete and correct. An electronic
signature is not valid.
__________________________________________________________
N
ON-TAX FILER SIGNATURE DATE
Please return this form to the Financial Aid Office at the location you plan to attend:
Central Community College – Columbus PO Box 1027 Columbus, NE 68602-1027 Fax: 402-562-1290
Central Community College – Grand Island PO Box 4903 Grand Island, NE 68802-4903 Fax: 308-398-7407
Central Community College – Hastings PO Box 1024 Hastings NE 68902-1024 Fax: 402-461-2447
Central Community College – Kearney PO Box 310 Kearney, NE 68848-0310 Fax: 308-338-4041
WARNING: If you purposely give
false or misleading information,
you may be fined, sent to prison,
or both.
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NON-TAX FILER 2020-21 VERIFICATION OF INCOME FOR NON-TAX (Central Community College)

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Completed 26 July 2020

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