I,   First Name*   Last Name*  (the applicant), certify that I do not receive income from any of the following sources: 

• Wages from employment (including commissions, tips, bonuses, etc.); 
• Rental income from real or personal property; 
• Interest or dividends from assets; 
• Social Security payments, such as Supplemental Security Income, Social Security Disability Income, Retirement, Survivor’s Benefits, annuities, insurance policies, pensions, or death benefits; 
• Unemployment
• Periodic allowances such as alimony, child support.
•  

 You are required to provide two months of statements from your bank or the financial institution you use (Bank, Venmo, Cash App, Chime, or others).

Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge.

Signature*   Applicant

Date*   

I,   First Name*   Last Name*  (SPOUSE/Legal Partner), certify that I do not receive income from any of the following sources: 

• Wages from employment (including commissions, tips, bonuses, etc.); 
• Rental income from real or personal property; 
• Interest or dividends from assets; 
• Social Security payments, such as Supplemental Security Income, Social Security Disability Income, Retirement, Survivor’s Benefits, annuities, insurance policies, pensions, or death benefits; 
• Unemployment
• Periodic allowances such as alimony, child support.
•  

 You are required to provide two months of statements from your bank or the financial institution you use (Bank, Venmo, Cash App, Chime, or others).

Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge.

Signature*   SPOUSE/Legal Partner

Date*   

I   First Name*   Last Name* (dependant), do hereby certify that all the above income information for the past 3 months is true and correct.

Signature*   Dependant
Date*