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SELF-ATTESTATION OF INCOME PLT# (office use only) Please complete the information below if you cannot document your income. Patient Name: SSN (Optional): Address: City: State: Zip Code: All items.

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The definition of an attestation is the act of showing or evidence showing that something is true. A letter of recommendation is an example of an attestation. A thing that serves to bear witness, confirm or authenticate.

Attestation of Income form can be used in place of an affidavit.

Self-Attestation for No Income. I _________________________________ certify that I have not been employed, self-employed, completed odd jobs, or had any source of income including gifts or loans during the past 30 days.

“I certify that [first and last name of person employed or receiving income] is/was an employee of [name of company]. [Employee name]'s gross income for this pay period is/was $__________ and frequency of pay is [weekly, every two weeks, twice a month, or monthly]. This letter does not guarantee employment or wages.”

Attestation is a kind of testimony or confirmation. It is customary to sign a deed, make a will or sign other written documents in the presence of a witness who also signs the document to attest to its contents and the authenticity of the party's signature.

This is a written statement that permits the documentation of eligibility for the program based on any ONE or MORE of the following. criteria: ● Household Income. ● Financial Impact (e.g., unemployment, reduction in income, significantly increased expenses, or other financial hardship)

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232