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Declaration of No or Low Income

Declaration of No or Low Income

Declaration of Household Size

Family Size

Declaration of Family Income

Family Income (Select the income immediately higher than your family's estimated taxable income)

Example

If your family's taxable income was $44,790, you would select the next highest amount, i.e. $49,440.

By initialing this form below, I warrant the truthfulness of the information provided in this income declaration and understand that it constitutes a legally binding signature. Falsification of any information herein constitutes a federal offense that may result in a fine or imprisonment