Financial Aid Office
United States University
140 W. 16
National City, CA 91950
STUDENT’S (PARENT’S) CERTIFICATION OF NON-FILING
2010-2011 AWARD YEAR
Name of Student:
Social Security No.:
Name of Parent:
Parent’s Social Security No.:
I/we hereby certify that I/we did not and will not file a 2009 Federal Income Tax Return because (check all that apply to you):
I/we did not work during 2009.
I/we worked during 2009, but did not file a 2009 Federal Income Tax Return. I/we earned $___________ in 2009. Please see
attached copy of my 1722 from the Internal Revenue Service.
I/we earned $______________ in interest/dividend income.
I/we received other income during 2009 from sources not included in amounts above. Those sources were as
I/we received non-taxable income during 2009 from the following sources:
6. My/our total income from all sources for 2009 was $_________________. (Total of lines 1 through 5)
I swear and affirm that the above information is true and correct to the best of my knowledge. I understand that any false statements or
misrepresentations will be cause for denial, reduction, withdrawal, and/or repayment of financial aid from federal, state, and institutional sources, and
may subject applicant to a fine or imprisonment or both, under provisions of the United States Criminal code. I also agree to provide official
confirmation of any of the above information and understand that US University may ask for an official verification of non-filing status directly from the
PLEASE SEE ATTACHED MY 1722 FORM FROM THE INTERNAL REVENUE SERVICE.
Internal Revenue Service.