Approved 13119 Applicant Household Member Household Member Na me Date of Bi rth Preferred Name ID: 827259
Download Pdf The PPT/PDF document "VERIFICATION OF NO INCOME (VONI)" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Approved 1/31/19 VERIFICATION O
Approved 1/31/19 VERIFICATION OF NO INCOME (VONI) Applicant (Household Member) Household Member Name: __________________________________ Date of Birth: ________________ Preferred Name: _______________________________________________________________________ Housing Situation: ☐ Living with friend/relative/roommate ☐ Renter ☐ Homeowner ☐ Dorm ☐ Homeless ☐ Shelter Food Situation: ☐ Food provided by friend/relative in household ☐ Food paid for by friend/relative ☐ Soup kitchen ☐ Food pantry ☐ Food stamps Person Supporting Applicant I have been providing the applicant with the following: Housing: ☐ Housing in my home ☐ Money for housing ☐ Bed at a shelter Food: ☐ Food in my home ☐ Money for food Other: ☐ $________/month for other expenses (NOT housing or food) I certify that to the best of my knowledge, the applicant is not receiving any type of income at this time. Name: ______________________________________ Relationship to Applicant: ___________________ Address: _____________________________________________________________________________ City: _______________________________________ State: _____________ Zip Code: ______________ Phone Number: _______________________Country (if outside of USA): __________________________ Signature: __________________________________________ Date: _____________________________