Self Verification of No Income

I, , hereby certify, under potential penalty of perjury, as of May 30, 2020 that I am not receiving any amount of steady income from any source whatsoever.

I also acknowledge that by signing this document I am aware that any false reporting of income will result in the immediate termination of Temporary Financial Assistance and may cause punitive legal action against me.

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Signature Certificate
Document name: Self Verification of No Income
Unique Document ID: 4c3da8283b1f7b54d071202a1e3d408aff598098
Timestamp Audit
April 27, 2020 9:34 am EDTSelf Verification of No Income Uploaded by Clinton Johnson - IP
May 1, 2020 9:28 pm EDTFront Desk - added by Clinton Johnson - as a CC'd Recipient Ip: