I (we) hereby certify that I (we) do no individually receive income from any of the following sources:

• Wages from employment (including commissions, tips, bonuses, fees, etc)
• Income from operation of a business
• Rental income from real or personal property
• Interest or dividends from assets
• Social Security payments, annuities, insurance policies, retirement funds, pensions, or death benefits
• Unemployment or disability payments
• Public Assistance payments
• Periodic allowances such as alimony, child support, or gives received from persons not living in my household
• Sales from self-employed resources (Avon, Mary Kay, Skaklee, etc)
• Any other source not named above

I (we) currently have no income of any kind and there is no imminent change expected in my financial status or employment status during the next 12 months