176x Filetype PDF File size 0.22 MB Source: www.centraltexas4c.org
Self-Declaration Letter This form needs to be filled out by any parent or guardians who are unemployed, self-employed, or who, for any reason, do not have tax form, W-2 forms, check stubs, or documents to verify their income. I, , claim my income or support comes from □ Self-employment (Explain) □ Seasonal employment/ Irregular employment, Paid cash (circle which applies) □ Parent / Family □ Other That Income or support is equal to an average of $ per month. Reason(s) for no-documentation given: Print Name Signature Date Staff Signature Date Staff Signature Date
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