INCOME INFORMATION Clause Samples
INCOME INFORMATION. Yes No MONTHLY GROSS INCOME I am self employed. (List nature of self employment) (use net income from business) $ I have a job and receive wages, salary, overtime pay, commissions, fees, tips, bonuses, and/or other compensation: List the businesses and/or companies that pay you: Name of Employer 1) 2) 3) $ $ $ I receive cash contributions of gifts including rent or utility payments, on an ongoing basis from persons not living with me. $ I receive unemployment benefits. $ I receive Veteran’s benefits/income. Administration, GI ▇▇▇▇, or National Guard/Military $ I receive periodic social security payments. $ The household receives unearned income from family members age 17 or under (example: Social Security, Trust Fund disbursements, etc.). $ I receive Supplemental Security Income (SSI). $ I receive disability or death benefits other than Social Security. $ I receive Public Assistance Income (examples: TANF, AFDC) $ I am entitled to receive child support payments. I am currently receiving child support payments. If yes, from how many persons do you receive support? I am currently making efforts to collect child support owed to me. List efforts being made to collect child support: $ $ I receive alimony/spousal support payments $ I receive periodic payments from trusts, annuities, inheritance, retirement funds or pensions, insurance policies, or lottery winnings. If yes, list sources: 1) 2) $ $ I receive income from real or personal property. (use net earned income) $ Student financial aid (public or private, not including student loans) Subtract cost of tuition from Aid received $ YES NO INTEREST RATE CASH VALUE I have a checking account(s). If yes, list bank(s) 1) 2) % % $ $ I have a savings account(s) If yes, list bank(s) 1) 2) % % $ $ I have a revocable trust(s) If yes, list bank(s) 1) % $ I own real estate. If yes, provide description: $ I own stocks, bonds, or Treasury Bills If yes, list sources/bank names 1) 2) 3) % % % $ $ $ I have Certificates of Deposit (CD) or Money Market Account(s). If yes, list sources/bank names 1) 2) 3) % % % $ $ $ I have an ▇▇▇/Lump Sum Pension/▇▇▇▇▇ Account/401K. If yes, list bank(s) 1) 2) % % $ $ I have a whole life insurance policy. If yes, how many policies $ I have cash on hand. $ I have disposed of assets (i.e. gave away money/assets) for less than the fair market value in the past 2 years. If yes, list items and date disposed: 1) 2) $ $ STUDENT STATUS YES NO Does the household consist of all persons who are full-time st...
INCOME INFORMATION. Enter the total family size from your current federal tax return
INCOME INFORMATION. Yes No MONTHLY GROSS INCOME I am self employed. (List nature of self employment) (use net income from business) $ I have a job and receive wages, salary, overtime pay, commissions, fees, tips, bonuses, and/or other compensation: List the businesses and/or companies that pay you: Name of Employer 1) $
INCOME INFORMATION. Do you receive any of the following? Indicate if received money from: • Supplemental Security Income (SSI) Benefits Yes No • Social Security Disability Benefits Yes No • Social Security Dependent Benefits Yes No • Social Security Survivor’s Benefits Yes No • Social Security Retirement Benefits Yes No • NYS Disability Yes No How do you see the trust money being spent? Referral Source: Name email:
INCOME INFORMATION. Enter the total number of claimed exemptions from your current federal tax return
INCOME INFORMATION. Monthly Income Sources Applicant Co-Applicant Combined Monthly Income Total Combined Monthly Income $
INCOME INFORMATION. Please provide proof of total household income (i.e. Check Stubs, Bank/Financial Statements, SSI/Disability Letters, etc.)
INCOME INFORMATION. Enter the total family size from your current federal tax return 3 This includes you, your spouse if filing jointly, and all dependents listed on your Federal 1040, including qualifying relatives. If you are 18 years and have no children, then you are a family of 1
INCOME INFORMATION. Homebuyer has submitted an Applicant Affidavit and additional information verifying income eligibility to City and Participant prior to execution of this Agreement. Homebuyer represents, warrants, and declares under penalty of perjury to City that all information Homebuyer has provided and will provide in the future to City is and will be true, correct and complete, and that there are no material omissions or misrepresentations in such information. Homebuyer acknowledges that City is relying upon Homebuyer’s representations that Homebuyer is an Eligible Household as set forth in the Guidelines, and that City would not have entered into this Agreement if Homebuyer did not so qualify.
(a) If Homebuyer willfully and knowingly makes a false statement or representation, or knowingly fails to disclose a material fact for the purpose of application to and qualifying for the Program, or, in completing certifications, affidavits, or recertification documents he/she/they will be subject to any and all legal remedies available under federal, state, and local laws, including applicable criminal and civil laws and regulations.
(i) When completing any Program document, Homebuyer shall be aware that by completing, submitting, and/or signing any Program document he/she/they is/are acknowledging that any material misstatement, material omission, or fraud, in any such document is and will be made under penalty of perjury and subject Homebuyer to legal remedies available under applicable criminal and civil statutes.
INCOME INFORMATION. Everyone must answer all questions in this section.