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2021-2022 Dependent Verification Worksheet (V1) Your Free Application for Federal Student Ald (FAFSA) was selected for verification. Federal ‘egulations require schools to confirm and correct FAFSA Information before awarding federal student ald, You and a parent must complete and sign this worksheet, attach any required ‘documents and submit to the financial ald office before your financlal aid can be processed, armss Billingsley. Morgan, ict ane Raden Hiitiame — Fata wi Fade Sc Na 60 Harbor se 62am ude’ Set de Tred op na) Tadewtsonectih Musou iy % is9 ay wae Tide Sets Fae Phone Nobor 2.165679, ‘Student's Email Address Srudents Alternate or Cel Phone Number Step 2: Parent Household Size Include he following in your parent’ curtent household se: “= Yoursalt + Your parent) 8) if unmarsied and not ving together, Ist parent who's information wae reported onthe FAFSA if unmarried, but ng together, incude bot patente iftemaregincude step-parent + Yourlsed parents" othe ehiseen if 8} your parent(s wil provide mare than haf of the cis uppor fom uly 2, 2021 through une 30,2022 or the chdren are reqied to provide parental information when apping fo Federal Student Ais + Other people who now vein your sted parents) household that your parent] will revde more than haf their suppor fr fom July, 2021trough ne 30, 202. FuilName ‘mee | Relationship Name of Calle (i ateast half ie 202-2022) Secs Mian y |e Edward Waters Calege Reshonds Tate 31 parent My Bilingaey a1_| ater Howard Univeity Myles Blingley a ‘mere space is needed, atach a separate page wth te stents name and soil secu number athe top. Sudetstane MOPTISEY _ soy, ‘Step 3: Student's Income Information Complete One Section Only ‘Section A: ONLY TAX FILERS - Complete This Section [Check only one box that applies: © The student has use the nS Date Retrieval Tool in FAFSA on the Web to transfer 2019 income taxre~ ‘um information into the student FAFSA. “The student gid nt inital use the IRS Data Retrieval Too, but wil submit a corection to the FAFSA on the Web usi ing the IRS DRT to transfer 2019 IRS income tax return information into the FAFSA. The student is unable or chooses not to use the IS Data Retrieval Tool n FAFSA on the Wee. Altachs Student must submita 2019 IRS Tax Return Transcript tothe school To obtain a copy visit ‘ and click on “get your tax record” or cll 1-800-908-9946. (The student ia victim of tax identity theft and is unable to obtain a 2019 Tax Return transcript o use the IRS Data Retrieval Too ‘tach Student must contact the IS at 3-800-908-4490 and upon authentication of identity receive * stanseript called @ TROBV (Transcript Database View), Submit tothe school once received ‘Section 8: ONLY NON-TAX FILERS - Complete Ths Section (Cheek only one box that applies: ‘The student was nat employed and had no income from workin 2019. The student was employed in 2019 and has listed below the names of employers and the amount earned from each employer in 2018. List every employer, even ifthe employer did not isue a W-2. Attach: A copy of all W-2's or IRS Wage and income transcripts. Employers Name 2019 Amount Earned | _IRSW-2attached? ‘Suzys Auto Body Shop (example) {$2,000.00 (example) Yes (example) Babysiting $580 No students Nome: Morgen Bipey__gsy,_44217055 ‘Step 4: Parent's Income information Complete One Section Only ‘Section A: ONLY TAX FILERS - Complete This Section (Check only one box that applies: ©. The parent(s) listed in Step 2 used the IRS Date Retrieval Tool in FAFSA on the Web to transfer 2019 in: ‘come tax return information into the student FAFSA. 1 The parent(s} did not intally use the IRS Data Retrieval Tool, but ‘on the Web using the IRS DRT to transfer 2019 IRS income tax return information into the FAFSA, jill submit a correction to the FAFSA foo in FAFSA on the ‘The parent(s) sted in Step 2s una etre Web. u tach: Parents) sted in Step 2 must submit a 2019 RS Tax Return Transcript to the school. To ob- copy Vist wannis.govand cick on “get your tax record reall 600-208-9946. 5 The parents filed separate 2019 RS income tax returns so the IRS DRT cannot be used. ‘Atach: Each parent must submit a 2019 18S Tax Return Transcript tothe school. To obtaln 2 copy Visit and click on “get your tax record” or call 1-200-908-8946. 5. The parents) sted in Step 2s a victim of tax identity theft and is unable to obtain a 2019 Tax Return ‘transcrip or use the IRS Data Retrieval Too. Attach: Parent{s) must contact the IRS at 1-800-908-4490 and upon authentication of identity, re ceive 2 transcript called a TRDBV (Transcript Database View). Submit tothe school once received. Section B: ONLY NON-TAX FILERS - Complete This Section [Check only one boxthat apples 1. The parents) were not employed and had no income from workin 2028, ‘Attach: 4) Parent(s) must submit an IRS Verification of Non-Fling Letter (Dated after October 1, 2019) from ‘wits. gov or 1-800-508-9946, and 2) Parent(s) submit Appendix A *Non-TaxFler's Statement” which is the last page attached to this Worksheet to describe how they supported themselves with no income in 2019, [The parent(s) were employed in 2019 and lsted below the names of employers and the amount earned from each employer in 2039, List every employer, even ifthe employer did not isue a W.2. Attach: 4) Parent(s) must submit an IRS Verification of Non-Filing Letter (Dated after October 1, 2020) from \ oF 1-800-908-9946, and 2) Parent(s) submit a copy of al W.2's or IRS Wage & Income transcripts and 3) Parent(s) submit Appendix A “Non-Tax Flers Statement” (last page attached to this worksheet). Employers Name 2019 Amount Earned] IRSW-2attached? Sua’ Auto Body Shop (example) $200000(e0mpte) | _Yes(eramele) Students Name: Morn Bingley sey, 44z-i7ss Sten 5: Family 2019 Untaxed income & Financial Information Directions: Answer every question. Ifa question does not apply to you write“ ‘the amount eavng tems lank may result n processing delays. Untared income ‘Mowing, food a other ning allowances pai to members of miltary, rey and others iuing cash pment and cash value of benef Do net include the vale of on-base miltary housing or the vale of bast tary allowance or housing, 2 Cash received or any money ld on your behalf in 2019 3.2019 Unordita abun or pndonannates chek the 2018 tax etn fr: (RS frm 2040:nes (a plus 4c minus (4 plus) «untaxed Portion) Total untaxed amount received in 2019 35 the above amount reinvested na retirement account? 2 2015 payments to tad person and savings plans ul oc or withheld rom earnings) such as 40 ead 403 plane. Check student and Parents 72 forms, box 12 trough 12d (Codes DEF, &$} Total mount received in 2013: 5. Untaxed Veteran’ 2019 Benefits *) Seat person eat person, dependency indentyconpensr- $2. ‘on, ete. Total ameunt received in 201 ) 2019 untaxed veteran aeministration education work tudyslowances$. received in 2038, § hr 209 nena at goed oh war Tcmpea ‘on daly crnporencteaung acamcteaeom $4 ag rosea 7. Got liana ulna io eg ia : 7 ecesstten en ieauinieiemmitureeeemnss $0 go the adjusted gross income onthe 2019 ede! ox return? Was this amount claimed 3s income on 2019 tax return? 5. 20:9 ale earsngs rom eer work ta rte needed work $a s programs. Wis this income reported on 2019 tax returns? 2y a that was taxable Bae aes eas 9, Combat payor special combat py. Only include amount th ad included in your parent’ adjusted goss income, Please attach W2. somo $ o | (lle One: Ye5/ M2 Cicle One: Yes/No College where 2019 Income was eares 10. Eaming from work under cooperative education program offered bya | scoot. pease tach W2, aor) s. Student’ Mame Morgen Bingley ‘Step 6: Parent Other Information to be Verified Child Support Paid / Received in 2019 3m srs Peat e ae Pid the student’ parent payor receive child support in 2019? Check one: [1 ¥E5/«) NO YES, please complete the following: "Name of Person Who Paid Ghid Name of rion t whom Name of hidfor Whom | Amount of chia Support Support Child Support Was Pld Suppor Was Pld Paidin 2019, ort ones fexampte) Chisy Sot exemple) | Terry Jones example) $6:000.0 (examsle) By signing below, you and your parent cet ‘ments is accurate and true, You acknowled ‘and respond ina timely manner toa Warning: f you purposefully give false or mislea) jar B Student Signature BeShanda Tate Parent Signature remember ‘Step 7: Certification and Signatures allure to answer ALL questions and submit 2019 tax return tan documents will esultin delayed processing of your le. Your state and federal until your verification is complete, ote Oe scripts, W2s and any other requested financial ald awards wil nt disburse ‘Submit this worksheet with all supporting financial documents to: ‘Attn: Financial Ald office 1658 kings Rd, Jacksonville, FL 32209 Fax(904) 470 - 8042 Phone:(904) 470-8190 fy that all the information reported on ths form and any attached docu- ie itis your responsibility to monitor your Financial aid fer any updates ional requests for documentation or canfcation infgrmaton, you may be fined, sent to jal or both. 7821] --] 7621 ]-6-2I Appendix: A Parent Non-Tax Filer’s Statement "Complete tis fem ifn ene eye let this form ifn Step 4: Parents income information you completed Section B as » Non Tax Fler, TI Ella iP a aw En ne Student’s Name ‘Student’s Social Security Number SMO ssh ene oe asa Parent's Name Parent's Socal Security Number {st below allthe sources and amounts of maney You receved from January 1, 2019 to December 33, 2018 "Tan answers nt applieable write $, Do not eave any pat bank, Please eport annua amounts received jes Source of income iE ‘Annual Amount Socal eet come 7 Workers comp 5 Unemployment : Non - Financial Support from Others 3 (he, food, housing, child care, etc.) potable shu tad = 5 pC eee aa Federal Benefits Received : Circle Yes or No MCSE (16/Mo)__SAAP(es/No) WHE s/o) Freor ede Linch (er/ No) TANF H/o) | Description of Circumstances Please describe the circumstances regarcng your income nthe space provided below. This should explain how you sup- Ported yourself and family with the limited 2018 income reported on the FAFSA nd EWC verification worksheet. Parent's Signature Date Signed

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