University Certification Of Income (Dependent) - 2015/2016

ADVERTISEMENT

Furman University
2015-2016 Certification of Income
DEPENDENT
_______________________________
__________________________
STUDENT’S NAME (please print)
SS # OR Furman ID #
______________________________________________________________________
Parent’s Name(s) (please print)
Marital Status: (please circle) Married Single Divorced/Remarried
Divorced
You have shown insufficient resources for basic living expenses. Please list your monthly 2014
income, and the expenses you paid from this income.
NOTE: If you are dependent, your parent must complete this form.
INCOME/RESOURCES
2014 Monthly Income/Resources
Income from work- Not reported on a W-2 Form……………….$_______________________/Mo
Income from work- W-2 Form(s) Received…………………….$_______________________/Mo
Rental Income from Properties…………………………………..$_______________________/Mo
ADC (Including child care)……………………………………...$_______________________/Mo
Child Support/Alimony………………………………………….$_______________________/Mo
Social Security Benefits…………………………………………$_______________________/Mo
Food Stamps……………………………………………………..$_______________________/Mo
Subsidized Housing……………………………………………...$_______________________/Mo
Pension…………………………………………………………..$_______________________/Mo
Unemployment…………………………………………………..$_______________________/Mo
Workers’ Compensation…………………………………………$_______________________/Mo
Military Allowances……………………………………………..$_______________________/Mo
Unsecured Loans……………………………………………….. $_______________________/Mo
Other Income/Resources: If someone pays for your living
expenses, please include the monthly dollar value of the
support, even if no money was actually paid to you and
provide a signed written statement from the provider.
Please explain:________________________________________
____________________________________________________$______________________/Mo
2014 TOTAL MONTHLY INCOME/RESOURCES $______________________/Mo
MONTHLY EXPENSES
2014 Monthly Expenses
Rent/Mortgage Payment (provide receipt)…………………….$_______________________/Mo
Utilities (phone, power, water, cable, heating) (provide bills) .$_______________________/Mo
Food..…………………………………………………………...$_______________________/Mo
Automobile: Fuel, repairs, insurance (provide statement)………$______________________/Mo
Medical/Dental………………………………………………….$_______________________/Mo
Miscellaneous: Day Care, etc (provide receipt)………………...$_______________________/Mo
2014 TOTAL MONTHLY EXPENSES
$_______________________/Mo
Attach a SIGNED and DATED photocopy of your (if applicable) and your parent’s 2014 U.S. Tax Return
1040/1040A/1040EZ to this form. Include all schedules and W-2 forms. If you have additional comments about
your living expenses or income resources, please attach another sheet.
_________________________________________________________
___________________________
STUDENT SIGNATURE
DATE
_________________________________________________________
___________________________
PARENT SIGNATURE
DATE

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Universal Certificate Of Residence For Employees - Lancaster County Tax Collection Bureau Universal Certificate Of Residence For Employees - Lancaster County Tax Collection Bureau Financial
Form 41a720rr-e - Schedule Rr-e - Application And Credit Certificate Of Income Tax/llet Credit Railroad Expansion - 2016 Form 41a720rr-e - Schedule Rr-e - Application And Credit Certificate Of Income Tax/llet Credit Railroad Expansion - 2016 Financial
Schedule Eth (form 41a720eth) - Application And Credit Certificate Of Income Tax/llet Credit Ethanol - 2016 Schedule Eth (form 41a720eth) - Application And Credit Certificate Of Income Tax/llet Credit Ethanol - 2016 Financial
Form 41a720cel - Schedule Cell - Application And Credit Certificate Of Income Tax/llet Credit Cellulosic Ethanol - 2016 Form 41a720cel - Schedule Cell - Application And Credit Certificate Of Income Tax/llet Credit Cellulosic Ethanol - 2016 Financial
Form 41a720bio - Schedule Bio - Application And Credit Certificate Of Income Tax/llet Credit Biodiesel - 2016 Form 41a720bio - Schedule Bio - Application And Credit Certificate Of Income Tax/llet Credit Biodiesel - 2016 Financial
Form 41a720rr-e - Schedule Rr-e - Application And Credit Certificate Of Income Tax/llet Credit Railroad Expansion - 2015 Form 41a720rr-e - Schedule Rr-e - Application And Credit Certificate Of Income Tax/llet Credit Railroad Expansion - 2015 Financial
Form 41a720bio - Schedule Bio - Application And Certificate Of Income Tax/llet Credit - Biodiesel - 2015 Form 41a720bio - Schedule Bio - Application And Certificate Of Income Tax/llet Credit - Biodiesel - 2015 Financial
Schedule Eth (form 41a720eth) - Application And Credit Certificate Of Income Tax/llet Credit Ethanol - 2015 Schedule Eth (form 41a720eth) - Application And Credit Certificate Of Income Tax/llet Credit Ethanol - 2015 Financial
Shedule Cell (form 41a720cell) - Application And Credit Certificate Of Income Tax/llet Credit - Cellulosic Ethanol - 2015 Shedule Cell (form 41a720cell) - Application And Credit Certificate Of Income Tax/llet Credit - Cellulosic Ethanol - 2015 Financial
Schedule Eth - Kentucky Application And Credit Certificate Of Income Tax/llet Credit Ethanol - 2015 Schedule Eth - Kentucky Application And Credit Certificate Of Income Tax/llet Credit Ethanol - 2015 Financial

Related Categories

Parent category: Business
Download
Go