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Fill and Sign the Before Me the Undersigned Authority on This Day Personally Form

Fill and Sign the Before Me the Undersigned Authority on This Day Personally Form

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Open the document and fill out all its fields.
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State of County of Affidavit of No Income Personally appeared before me, the undersigned authority in and for said county and state, _______________________ (Name of Affiant) , who, having been being first duty sworn by the undersigned Notary Public, deposes and says:1. My residence address is __________________________________________________ _____________________________________________ (street address, city, county, state, zip code).2. I am _______________________________________ (single or married or separated or divorced; if married, state full name of spouse).3. I have _________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ [no dependents, or, the following dependents: (state names and relationships, and monthly amounts of support contributed for each)].4. I am ______________________________________________________ [unemployed, and have been unemployed since (date of last employment].5. I hereby certify that I do not individually receive income from any of the following sources:A. Wages from employment (including commissions, tips, bonuses, fees, etc.);B. Income from operation of a business;C. Rental income from real or personal property;D. Interest or dividends from assets;E. Social Security payments, annuities, insurance policies, retirement funds, pensions, or death benefits;F. Unemployment or disability payments;G.Public assistance payments;H.Periodic allowances such as alimony, child support, or gifts received from persons living in my household;I. Sales from self-employed resources;J. Any other source not named above. 6. I currently have no income of any kind and there is no imminent change expected in my financial status or employment status during the next 12 months.7. I will be using the following sources of funds to pay for rent and other necessities: (describe) _____________________________________________________________ ______________________________________________________________________.Witness my signature this ____________________ (date)._________________________________________ (Name and Signature of Affiant) SWORN to and subscribed before me, this the ____ day of ______________, 20____._____________________________NOTARY PUBLICMy Commission Expires:____________________

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