Alternative Document Of Income
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2Alternative Document of Income
SECTION 1: IDENTIFYING INFORMATION
Before completing this form, carefully read the instructions in each section
All borrowers must provide the Borrower Information below.
If you are married, you must provide the Spouse Information
below if you and your spouse file a joint federal tax return.
Spouse Information:
Borrower Information:
Your Spouse’s Name (please print clearly):
Borrower’s Name (please print clearly):
m
m
Last Name
First Name
Middle Initial
Last Name
First Name
Middle Initial
Borrower’s Social Security Number:
Borrower’s Social Security Number:
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SECTION 2: FAMILY SIZE
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Enter your family size.
Family size includes you, your spouse, and your children (including unborn children who will be born during the year for which
you certify your family size), if the children will receive more than half their support from you. It includes other people only if they
live with you now, they receive more than half their support from you now, and they will continue to receive this support from you
for the year that you certify your family size. Support includes money, gifts, loans, housing, food, clothes, car, medical and
dental care, and payment of college costs.
Note: If you do not enter your family size, it will be assumed as a family size of one. For the purpose of this repayment plan,
your family size may be different from the number of exemptions you claim on your federal tax return. By signing this form, you
.
are certifying that the family size you enter above is correct
SECTION 3: BORROWER’S INCOME INFORMATION
To be completed if you did not file a federal income tax return for the two most recently completed years.
You must list all taxable income you are currently receiving (i.e. income from employment, unemployment income, dividend
income, interest income, tips, alimony). Include the amount of money received, how often you receive this money, and your
employer (if any) or the source of your income if you are not employed. If you have more than two sources of income, provide
the information requested in this section on a separate piece of paper and mail it with this form. Do not report untaxed income
such as Supplemental Security Income, child support or federal or state public assistance.
Frequency of payment (Please Check the appropriate box)
Amount of
Employer or Source of Income
Income
Weekly
Bi-weekly
Semi-monthly
Monthly
Yearly
$
$
Check this box if you do not have any taxable income and receive only untaxed income such as
Supplemental Security Income, child support, or federal or state public assistance.
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