This document is a zero income affidavit that must be completed by adult household members with no income. It includes a certification that the signer does not receive income from any source like employment, business, rental properties, investments, government assistance, gifts, or self-employment. The signer certifies there is no expected change in financial status for 12 months and lists sources of funds that will be used to pay rent and necessities. Completing the affidavit with false information could result in lease termination.
This document is a zero income affidavit that must be completed by adult household members with no income. It includes a certification that the signer does not receive income from any source like employment, business, rental properties, investments, government assistance, gifts, or self-employment. The signer certifies there is no expected change in financial status for 12 months and lists sources of funds that will be used to pay rent and necessities. Completing the affidavit with false information could result in lease termination.
This document is a zero income affidavit that must be completed by adult household members with no income. It includes a certification that the signer does not receive income from any source like employment, business, rental properties, investments, government assistance, gifts, or self-employment. The signer certifies there is no expected change in financial status for 12 months and lists sources of funds that will be used to pay rent and necessities. Completing the affidavit with false information could result in lease termination.
This document is a zero income affidavit that must be completed by adult household members with no income. It includes a certification that the signer does not receive income from any source like employment, business, rental properties, investments, government assistance, gifts, or self-employment. The signer certifies there is no expected change in financial status for 12 months and lists sources of funds that will be used to pay rent and necessities. Completing the affidavit with false information could result in lease termination.
Development Name: ________________________________________________ Unit: ____________
1. 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 (Avon, Mary Kay, Shaklee, etc.); j. Any other source not named above.
2. 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.
3. I will be using the following sources of funds to pay for rent and other necessities:
Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge. The undersigned further understand(s) that providing false representations here- in constitutes an act of fraud. False, misleading, or incomplete information may result in the termination of a lease agreement.
SIGNATURE OF APPLICANT/TENANT DATE
Sworn to before me and subscribed in my presence this ________ day of _____________________, 20____.
SIGNATURE OF NOTARY PUBLIC NAME
My commission expires:__________________________
ZERO INCOME AFFIDAVIT 5/1/2010
ZERO INCOME AFFIDAVIT
Survival Statement
1. Do you own a vehicle? Yes No Monthly Car Payment $_____________
Monthly Auto Insurance $_____________ Monthly Gas Expense $_____________
Source of income for payment of car expense:
2. Do you have internet at home? Yes No How much do you spend? $_____________
Source of income for payment of internet:
3. Have you purchased any clothing for Yes No How much do you spend? $_____________ yourself or member of the household during the past 30 days? Source of income for payment of clothing:
4. Have you or a member of the household Yes No How much do you spend? $_____________ incurred any medical expenses in the past 30 days? Source of income for medical expenses:
5. Do you have telephone service in your Yes No Monthly Telephone Cost: $_____________ apartment? Monthly Cell Phone Cost: $_____________ Do you have a cell phone? Source of income for payment of telephone and cell phone cost:
6. Do you subscribe to cable television? Yes No Monthly Cable TV Cost: $_____________
Source of income for payment of cable TV:
7. Do you have any school age children? Yes No How much did you spend in the past 30 days for school related costs (books, paper, pencils, lunches, fees, etc)? $_____________
Source of income for payment of school expenses:
8. Do you or other household member Yes No Monthly cash contribution? $_____________
receive cash contributions for sources or persons outside the household? Source of income for cash contribution:
9. What was the total food cost for your family in the past 30 days? Source of income for food costs: 10. How much did you spend during the past 30 days for items such as soap, detergent, toothpaste, cigarettes, alcohol, deodorant, shampoo, toilet tissue, etc.? Source of income for the above items: 11. What were your utility costs for the past 30 days? Source of income for utility costs:
I have answered truthfully to the best of my ability to the above questions.
_______________________________________________________________________________________________ Signature of Tenant Date
