Fill and Sign the Proof of No Income Letter Form

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 PUBLIC My Commission Expires: ____________________