Form 21 Fpitey Tax Filers Income Verification - Fresno State

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2015-2016
FORM 21 - FPITEY
Financial Aid Office
5150 N. Maple Avenue, M/S JA 64
Fresno, CA 93740-8026
Phone: (559) 278-2182
Fax: (559) 278-4833
- PARENT(S) -
Tax Filers Income Verification
STUDENT ID
STUDENT LAST NAME
STUDENT FIRST NAME
PHONE NUMBER
(with area code)
PLEASE PRINT IN BLACK INK
In order to continue processing your student’s financial aid application, we need to verify your 2014 income and wages. We recommend
using the IRS Data Retrieval functionality on the FAFSA- which can still be used by submitting a correction at
. In most
cases no further documentation will be needed but, you could still be asked for additional information or documents to verify income.
1. Check the appropriate box below regarding your tax filing information:
(see instructions on page 2 for obtaining transcripts)
Successfully used the IRS Data Retrieval function on the FAFSA
FAFSA marital status is “Married” and tax filing status was
.
“Married Filing Separately”:
on
(date)
Attach copies of BOTH 2014 IRS Tax Return Transcripts
Unable to use IRS Data Retrieval function on the FAFSA:
FAFSA marital status is
“Unmarried-both parents living together”:
Attach your 2014 IRS Tax Return Transcript
Attach copies of BOTH 2014 IRS Tax Return Transcripts
Filed or will file a 2014 Foreign Tax Return
FAFSA marital status is Separated, Divorced or been Widowed
Attach a signed and translated copy of the foreign tax
and tax filing status was “Married Filing Jointly”:
return, showing the 2014 Adjusted Gross Income
and
(AGI)
Tax paid
Attach your 2014 IRS Tax Transcript AND copies of all 2014
W2, 1099, and K-1’s
2. Enter the answers for sources of income/support. Please enter zero (“0”) under “Amount” if you did not have the item.
PARENT 1 INFORMATION - Sources of Income/Support for 2014
(DO NOT LEAVE ANY ITEMS BLANK)
EMPLOYERS
2014 Amount
BENEFITS
OTHER SOURCES
2014 Amount
☐ TANF
$
☐Unemployment
$
☐ SNAP
$
☐ Workers’ Compensation
$
☐ SSB
$
☐ Disability
$
☐ SSI
K-1:
$
☐ Other:
$
☐ WIC
☐I was not employed and had no income earned from work in 2014.
(You need to complete a Parent Income Verification for Non-Filers form)
PARENT 2 INFORMATION - Sources of Income/Support for 2014
(DO NOT LEAVE ANY ITEMS BLANK)
EMPLOYERS
2014 Amount
BENEFITS
OTHER SOURCES
2014 Amount
☐ TANF
$
☐Unemployment
$
☐ SNAP
$
☐ Workers’ Compensation
$
☐ SSB
$
☐ Disability
$
☐ SSI
K-1:
$
☐ Other:
$
☐ WIC
☐I was not employed and had no income earned from work in 2014.
(You need to complete a Parent Income Verification for Non-Filers form)
3. If you have unusually low or no income reported above, please explain how the living expenses were paid in 2014:
CERTIFICATION & SIGNATURE(S)
By signing this worksheet, I (we) certify that all the information reported on it is complete and correct.
(Please Print)
Parent 1 Name
Parent 1 Signature
Date
WARNING: If
you purposely
give false or
(Please Print)
Parent 2 Name
Parent 2 Signature
misleading
information you
may be fined, be
sentenced to

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