Zero Income Affidavit Form - When you send us this form, please include a copy of the letter that we sent you asking for proof of your income. I, , hereby certify under the penalties of perjury and fraud the following: I do not currently receive any. I, _____ hereby certify that i do not individually receive income from any of the following sources: I, , do swear or affirm, under penalty if perjury that: This zero income determination worksheet must be completed by all heads of household reporting no ($0).
I, , do swear or affirm, under penalty if perjury that: I, , hereby certify under the penalties of perjury and fraud the following: I do not currently receive any. I, _____ hereby certify that i do not individually receive income from any of the following sources: When you send us this form, please include a copy of the letter that we sent you asking for proof of your income. This zero income determination worksheet must be completed by all heads of household reporting no ($0).