DOCUMENTS ARE REQUIRED BY MARCH 10, 2016

Size: px
Start display at page:

Download "DOCUMENTS ARE REQUIRED BY MARCH 10, 2016"

Transcription

1 The deadline for the submission of all Tuition Forms is MARCH 10, Failure to comply with this deadline will result in a $300 per child late filing penalty and your child(ren) placed on a waiting list. COPIES OF THE FOLLOWING DOCUMENTS MUST BE SUBMITTED WITH THE APPLICATION PLEASE CHECK ALL THAT APPLY DOCUMENTS ARE REQUIRED BY MARCH 10, Income Tax Notice(s) Of Assessment (2015 if available) Separation/Divorce Agreement. (If Applicable) T4( s) from 2015 Last pay statement(s) for 2015 showing Year To Date values or Two Most Current Consecutive Pay Slips Housing: Current Mortgage Statement at December 31, 2015 OR current Lease Agreement If a NEW home was purchased since February INCLUDE: Statement of Adjustments Mortgage Application Tax Free Savings Account (TFSA) Statement(s) Most Current Property Tax Assessment Registered Educational Savings Plan (RESP) Statement(s) Registered Retirement Savings Plan RRSP Statement(s) COPIES OF THE FOLLOWING DOCUMENTS ARE REQUIRED BY MAY 20, 2016 Complete Income Tax Return(s) For 2015 Include T4 s, schedules and etc. If this a first time application, please include 2014 Family Trust Returns. (If Applicable) Latest Year-End Accountant Prepared Financial Statements P&L, Balance Sheet, Cash Flow Statement, Etc. (If Applicable) Other Information May be Requested PLEASE ENSURE YOUR NAME AND ADDRESS ARE INCLUDED ON ALL DOCUMENTATION SUBMITTED Applications are assessed in chronological order when all documentation required is received. Failure to comply with the deadlines WILL result in the school not being able to guarantee a space for your child. First time Tuition SupportApplicants MUST provide Income Tax information from 2014 and 2015 PARENT / GUARDIAN INFORMATION Marital Status: Married Separated Divorced Re-Married Widow(er) Other Parent/Guardian #1 Parent/Guardian #2 Relation to Child Last Name First Name City Province Postal Code Phones: Home Cell Relation to Child Last Name First Name City Postal Code Phones: Home Cell Profession Business Information Profession Business Information Occupation Occupation Employer s: Name Employer s: Name Type of Business Type of Business Phone Phone Children Reside With 1 2 Both Correspondence sent to 1 2 Both 1

2 Name Age School Grade Tuition Fee 2015/2016 APPLICATION FOR TUITION SUPPORT PLEASE LIST ALL DEPENDANT CHILDREN THAT ATTENDED ANY SCHOOL OR CHILD CARE AS APPLICABLE IN 2015/2016 THE UJA FEDERATION PROVIDES SIGNIFICANT FUNDING FOR JEWISH EDUCATION INCLUDING TUITION SUPPORT. INCOME INFORMATION Total Income ( To Be Confirmed By The 2015 Income Tax Returns ) Income Line Father ($) Mother ($) Child ($) Total ($) Total Employment Earnings 101 Other Employment Income 104 Unemployment Insurance Benefits(T4u) 119 Taxable Amount Of Dividends 120 Interest And Other Investment Income 121 Rental Income 126 Taxable Capital Gains 127 Alimony Or Maintenance Income 128 RRSP Income 129 Other Income (Specify) 130 Net Self Employed Income (Specify ) Total Income ( Add Entire Column ) 150 Other Income: Gifts Or Other Assistance Tax Free Allowances (Eg: Car, Housing) Disability Benefits Income From Child Tax Benefit Total (Including Other Income) Total Estimated Income

3 Real Estate: Primary Residence APPLICATION FOR TUITION SUPPORT ASSETS: Purchase Date Purchase Price Approximate Current Value Was A Mortgage Taken Out To Finance The Purchase Of Your Home? Yes No Mortgages Please include copies of all current mortgage statements 1 st 2 nd 3 rd Amount Rate (APR%) Monthly Payment Term (Years) Property Tax Assessment Attach ALL Mortgage Documents Mortgage Held By: Do You Derive Rental Income From Your Home? Yes If Yes: Amount/Mo $ No OTHER REAL ESTATE Include Property in Other Countries Type\ Purchase Tax Purpose Price Assessment Current Value Was A Mortgage Taken Out To Finance These Properties? Yes No Mortgages Please include copies of all current mortgage statements Amount Rate (APR%) Monthly Payment Term (Years) 3

4 Registered Retirement Savings Plans: (RRSP) (Include copies of most recent statements) Father: Amount Invested 2015 $ Current Total RRSP Value $ Mother: Amount Invested 2015 $ Current Total RRSP Value $ Registered Educational Savings Plan (RESP (Include copies of most recent statements) Aggregate amount invested for all children in 2015 $ Current total RESP value for all children $ Cars, Trucks and other Vehicles (Owned or Operated in the Family): Year/Make/Model Plate # Date Purchased Purchase Lease \Finance Amount Price Cost per month Owing Company Car $ $ $ Yes No $ $ $ Yes No $ $ $ Yes No Bank Balances, Stocks, Bonds, GICs, TFSAs, Limited Partnerships and other Securities/Investments (including in other countries): Description Purchase Date Purchase Amount Current Value/Balance $ $ $ $ $ $ Intangible Assets (eg: taxi/limo license, royalties etc.) Description Market Value $ $ Businesses- Incorporated and unincorporated in which you or an immediate member of your family have an ownership interest: ( Submit financial statement with application ): Name of business % owned Current Value ( of % owned ) % $ % $ Do you or any member of your family have an interest in a trust or estate? If so : Family member Description Current Value Annual Distribution $ $ 4

5 FINANCIAL INFORMATION - FAMILY EXPENDITURES I Expenditures I Deductions from Line 150 Income Canada Pension Plan Credit Union Loan Credit Union Savings Group Insurance Premiums Income Tax (Line Total Father's And Mother's) Registered Pension Plan Contributions Unemployment Insurance Premiums Food and Sundries General Household Supplies Groceries Laundry, Dry Cleaning Dining Out Housing Mortgage Real Property Taxes (Include copy of Property Tax Assessment) Rent-----Paid To: (Include copy of Lease Agreement) Home Insurance Premiums Electricity Heating Repairs And Maintenance Cable TV Telephone Internet Access Water Gardening And Snow Removal Savings Registered Retirement Savings Plan Contributions Unreimbursed Health Costs (Including Drugs) Dentist (Regular Care) Doctors, Chiropractors Prescription Drugs Group Insurance Premiums Or Private Health Life Insurance Premiums Orthodontist Or Special Dental Care PLEASE TOTAL Subtotal I 2015 Actual 2016 Estimated Enter Monthly or Annual $ Enter Monthly or Annual $ Monthly Annual Monthly Annual 5

6 Expenditures II (continued) Clothing Children Parents Miscellaneous Alimony And Maintenance Paid Annual Union, Professional, Or Like Dues Babysitting, Daycare, Housekeeper Bar/Bat Mitzvah Camp - Child: Camp: Camp - Child: Camp: Camp - Child: Camp: Charitable Contributions (other than from tuition fees) Child In Other Educational Institute (Including University & Yeshiva) Where: 1) 2) Children s Activities- Specify: Children s Allowances Children's Tutoring Specify: Daycare And/Or Pre-School Fees Gifts Recreation/Entertainment Alimony/child support (Include copy of settlement agreement) Support To Parents/Family. Specify: Synagogue Dues Tuition, Fees, Books, Etc. Vacation- Where? 1: 2: 3: Transportation Car Insurance Premiums Gasoline, Oil Parking Public Transit Taxis, Car Pools Loan Payments Banks/Line of Credit Balance Car Loan/Lease Payment Vehicle 1: Yr: Car Loan/Lease Payment Vehicle 2: Yr: Credit Unions Finance Companies Credit Card 1 Type Credit Card 2 Type Taxes Owing (Arrears) Other Model: Model: PLEASE TOTAL Subtotal II ( This Page ) PLEASE TOTAL Subtotal I ( Previous Page ) PLEASE TOTAL Total (Subtotals I + II) TOTAL LOAN 2015 Actual Payments Enter Monthly or Annual $ 2016 Estimated Payments Enter Monthly or Annual $ Monthly Annual Monthly Annual 2015 Actual Payments 2016 Estimated Payments Monthly Annual Monthly Annual 6

7 Special Circumstances you wish to point out (attach a letter or other documentation if applicable). I/We are unable to pay the full tuition fee and therefore request tuition support. We OFFER to pay a Family tuition fee of $ for the school year for all our children registered in the Jewish Day School system including both the elementary and high school levels in grades I/We understand that this offer is solely for my children attending both the elementary and high school levels grades 1-12 and does not include the cost of Pre School that is not subsidized in all schools. Junior Kindergarten (JK) and Senior Kindergarten(SK) at Associated are eligible for tuition support and offer the amount of $ for the school year for our children in attendance of JK and or SK Student expenses not included in the Grades JK-12 tuition fee will be the direct responsibility of the parents. We hereby verify that all information is complete and correct. We understand that the information will be reviewed and is subject to verification by the tuition committee and may be required to meet with a member(s) of the tuition committee. We further understand that the tuition committee will upon completion of this review notify us of the tuition amount the committee has determined appropriate as a family fee. I\We understand that any misrepresentation or non disclosure may void any agreed tuition and the school has the option to reevaluate the tuition, revoke any subsidy awarded or refuse admission to the school. Income and subsidy information and the assessment by this committee are subject to review by The Centre for Jewish Education. All information submitted and the results of this review are treated as strictly confidential. In submitting and signing this application form, we acknowledge and consent to the sharing of this information with members of the tuition committee, The Julia and Hemry Koschitzky, Centre for Jewish Education, and, in the case of families with children at more than one Jewish day school or, in the case of children who transfer to another Jewish day school, the professional staff and tuition committee members at the other Jewish day school(s). Signature of Father / Guardian Signature of Mother / Guardian Date: / / Date: / / day month yr. day month yr. ANY MISSING INFORMATION, DOCUMENTATION OR SIGNATURES WILL RENDER THIS APPLICATION INCOMPLETE AND MAY NOT BE PROCESSED UNTIL ALL REQUIRED INFORMATION IS RECEIVED In order to receive an Admit To Class Card In August all outstanding tuition accounts must in good standing prior to July 31, The UJA Federation provides significant funding for Jewish Education including tuition support. 7

AFFIDAVIT IN SUPPORT OF APPLICATION FOR SETTLEMENT

AFFIDAVIT IN SUPPORT OF APPLICATION FOR SETTLEMENT Financial Service Commission of Ontario Commission des services financiers de l'ontario AFFIDAVIT IN SUPPORT OF APPLICATION FOR SETTLEMENT THE MOTOR VEHICLE ACCIDENT CLAIMS ACT R.S.O. 1990, CHAPTER M.41,

More information

ONTARIO Court File Number. Form 13: Financial Statement (Support Claims) sworn/affirmed. Applicant(s) Respondent(s)

ONTARIO Court File Number. Form 13: Financial Statement (Support Claims) sworn/affirmed. Applicant(s) Respondent(s) ONTARIO Court File Number at (Name of Court) Court office address Form 13: Financial Statement (Support Claims) sworn/affirmed Applicant(s) Full legal name & address for service street & number, municipality,

More information

300-309 McDermot Avenue Winnipeg, Manitoba R3A 1T3 Telephone: (204)942-0300 Fax: (204)957-5611 Website: www.lazergrant.ca

300-309 McDermot Avenue Winnipeg, Manitoba R3A 1T3 Telephone: (204)942-0300 Fax: (204)957-5611 Website: www.lazergrant.ca **PLEASE COMPLETE IN INK** 300-309 McDermot Avenue Winnipeg, Manitoba R3A 1T3 Telephone: (204)942-0300 Fax: (204)957-5611 Website: www.lazergrant.ca Application for: Proposal By: Self I/We consent to receiving

More information

Financial Planning: Personal Guide & Checklist

Financial Planning: Personal Guide & Checklist Financial Planning: Personal Guide & Checklist Securities Priscilla Monteith, CPA, CGA, CFP Certified Financial Planner Monteith Financial Group Manulife Securities Incorporated Stephanie Piroli, BAccS,

More information

MIAMI BEACH JEWISH COMMUNITY CENTER APPLICATION FOR PROGRAM FEE REDUCTION

MIAMI BEACH JEWISH COMMUNITY CENTER APPLICATION FOR PROGRAM FEE REDUCTION MIAMI BEACH JEWISH COMMUNITY CENTER APPLICATION FOR PROGRAM FEE REDUCTION Note: All sections of this application must be completed in full. If any information is incomplete or missing, your application

More information

pages is accurate to the best of my knowledge and belief and sets out the financial situation as of (give date for which information is accurate)

pages is accurate to the best of my knowledge and belief and sets out the financial situation as of (give date for which information is accurate) ONTARIO Court File Number at (Name of Court) Court office address Form 13: Financial Statement (Support Claims) sworn/affirmed Applicant(s) Full legal name & address for service street & number, municipality,

More information

Form 70 I. (general heading) FINANCIAL STATEMENT OF

Form 70 I. (general heading) FINANCIAL STATEMENT OF Form 70 I (general heading) FINANCIAL STATEMENT OF INCOME AND MONEY RECEIVED (Include income and other money received from all sources, whether taxable or not, for the twelve month period ending on the

More information

ONTARIO Court File Number. Form 13.1: Financial Statement (Property and Support Claims) sworn/affirmed. Applicant(s) Respondent(s)

ONTARIO Court File Number. Form 13.1: Financial Statement (Property and Support Claims) sworn/affirmed. Applicant(s) Respondent(s) ONTARIO Court File Number at (Name of court) Court office address Form 13.1: Financial Statement (Property and sworn/affirmed Applicant(s) Full legal name & address for service street & number, municipality,

More information

ONTARIO Court File Number. Form 13.1: Financial Statement (Property and Support Claims) sworn/affirmed. Applicant(s) Respondent(s)

ONTARIO Court File Number. Form 13.1: Financial Statement (Property and Support Claims) sworn/affirmed. Applicant(s) Respondent(s) ONTARIO Court File Number at (Name of court) Court office address Form 13.1: Financial Statement (Property and sworn/affirmed Applicant(s) Full legal name & address for service street & number, municipality,

More information

***THIS FORM MUST BE COMPLETED IN FULL***

***THIS FORM MUST BE COMPLETED IN FULL*** BANKRUPTCY/PROPOSAL APPLICATION CHECKLIST 1. Application - complete all questions - bring 2 pieces of identification when you sign up (i.e. driver s licence & birth certificate) 2. Vehicles - copy of vehicle

More information

PLEASE SUBMIT ONLY ONE (1) APPLICATION PER HOUSEHOLD EVEN IF YOU ARE INTERESTED IN MORE THAN ONE (1) PROPERTY. THANK YOU.

PLEASE SUBMIT ONLY ONE (1) APPLICATION PER HOUSEHOLD EVEN IF YOU ARE INTERESTED IN MORE THAN ONE (1) PROPERTY. THANK YOU. Dear Applicant: Thank you for your recent inquiry of occupancy at a Carabetta Management Company apartment community. Due to the nature of Federal Assistance provided for these properties, we are required

More information

Denver Tax Group, LLC CHADWICK ELLIOTT 1888 Sherman Street SUITE 650 DENVER, CO 80203 (0) Organizer Mailing Slip

Denver Tax Group, LLC CHADWICK ELLIOTT 1888 Sherman Street SUITE 650 DENVER, CO 80203 (0) Organizer Mailing Slip Denver Tax Group, LLC CHADWICK ELLIOTT Sherman Street SUITE 0 DENVER, CO 00, (0) Organizer Mailing Slip TAX ORGANIZER TO:, FROM: Denver Tax Group, LLC Sherman Street SUITE 0 DENVER CO 00 (0) -0 Enclosed

More information

Personal Loan Guidelines

Personal Loan Guidelines Personal Loan Guidelines Loan applicants must live in Northeast Ohio and have an income, the ability to repay the loan and the inability to obtain the money from a conventional lender. The maximum loan

More information

Tax Return Questionnaire - 2013 Tax Year

Tax Return Questionnaire - 2013 Tax Year Print this form out, take some time to fill it out, and bring it with you when you come to the office. This will save you time and money, and help us help you more effectively. Tax Return Questionnaire

More information

Submitting your Financial Aid Application Online

Submitting your Financial Aid Application Online Documentation After completing the online application you will need to forward the following income documentation: 1) Page 1 and 2 of your 2013 US Individual Tax return (Form 1040, 1040A,or 1040EZ) 2)

More information

JEWISH FEDERATION OF METROPOLITAN CHICAGO 2016 SPRING HIGH SCHOOL ISRAEL EXPERIENCE SCHOLARSHIP APPLICATION

JEWISH FEDERATION OF METROPOLITAN CHICAGO 2016 SPRING HIGH SCHOOL ISRAEL EXPERIENCE SCHOLARSHIP APPLICATION JEWISH FEDERATION OF METROPOLITAN CHICAGO 2016 SPRING HIGH SCHOOL ISRAEL EXPERIENCE SCHOLARSHIP APPLICATION For programs beginning Summer 2016 through Fall 2016 This application must be submitted/postmarked

More information

Rio Homes Permanently Affordable Homes Application Process

Rio Homes Permanently Affordable Homes Application Process Rio Homes Permanently Affordable Homes Application Process Thank you for your interest in the third phase of the Rio Homes. This partnership between AZNORTH Development, Inc. and the City of Flagstaff

More information

3. If you received any interest from a "Seller Financed" mortgage, provide: Name and Address of Payer Social Security Number Amount

3. If you received any interest from a Seller Financed mortgage, provide: Name and Address of Payer Social Security Number Amount Print this form out, take some time to fill it out, and bring it with you when you come to the office. This will save you time and money, and help us help you more effectively. Tax Return Questionnaire

More information

NORTH BEND STUDENT LOAN FUND Inc.

NORTH BEND STUDENT LOAN FUND Inc. NORTH BEND STUDENT LOAN FUND Inc. A community-supported program c/o Student Services Center to assist North Bend students North Bend High School secure an advanced education. North Bend, Or 97459 GENERAL

More information

Total Monthly Income $ Miscellaneous Income Royalties, Trusts, and Other Investments $ Contributions from Others $ Dependent Children s monthly gross

Total Monthly Income $ Miscellaneous Income Royalties, Trusts, and Other Investments $ Contributions from Others $ Dependent Children s monthly gross District Court Denver Juvenile Court County, Colorado Court Address: In re: The Marriage of: The Civil Union of: Parental Responsibilities concerning: Petitioner: and Co-Petitioner/Respondent: Attorney

More information

1420 n. CLAREMONT BLVD., SUITE 101-B TEL (909) 398-4737 CLAREMONT, CALIFORNIA 91711 FAX (909) 398-4733

1420 n. CLAREMONT BLVD., SUITE 101-B TEL (909) 398-4737 CLAREMONT, CALIFORNIA 91711 FAX (909) 398-4733 1420 n. CLAREMONT BLVD., SUITE 101-B TEL (909) 398-4737 CLAREMONT, CALIFORNIA 91711 FAX (909) 398-4733 www.nicholscpas.com Email: info@nicholscpas.com January 12, 2015 RE: 2014 Tax Returns It is hard to

More information

Income Tax Organizer

Income Tax Organizer Income Tax Organizer This organizer will help you organize your tax information (and make sure that you don't miss important deductions). We hope you find it useful and informative! (This form was prepared

More information

Tax Return Questionnaire - 2015 Tax Year

Tax Return Questionnaire - 2015 Tax Year SPECTRUM Spectrum Financial Resources LLP FINANCIAL 15021 Ventura Boulevard #341 310.963.4322 T RESOURCES Sherman Oaks, CA 91403 303.942.4322 F www.spectrum-cpa.com Tax Return Questionnaire - 2015 Tax

More information

WSSS Policy on Tuition Assistance. Procedure

WSSS Policy on Tuition Assistance. Procedure WSSS Policy on Tuition Assistance Each family, regardless of its financial situation, is an important part of the Waldorf School of Saratoga Springs. Families who feel unable to pay full tuition are invited

More information

Sample Only. Grant & Aid Application For the School Year Beginning Fall 2012. Save Time Apply Online. Information needed to complete your application:

Sample Only. Grant & Aid Application For the School Year Beginning Fall 2012. Save Time Apply Online. Information needed to complete your application: 10000028406 Save Time Apply Online. Apply online at www.factstuitionaid.com - Applying online is the fastest and most direct method of submitting your application. It allows your institution to view your

More information

Business Loan Guidelines

Business Loan Guidelines Business Loan Guidelines Loan applicants must be businesses located in Northeast Ohio that are unable to obtain the money from a conventional lender or other sources The maximum loan amount is $10,000

More information

Collection Information Statement for Wage Earners and Self-Employed Individuals

Collection Information Statement for Wage Earners and Self-Employed Individuals Georgia Department of Revenue Collection Information Statement for Wage Earners and SelfEmployed Individuals Form CD14C (June 2012) Use this form if you are An individual who owes income tax on a Form

More information

INITIAL CLIENT QUESTIONNAIRE Financial. Name: SSN: DOB: Spouse: SSN: DOB: Address: City: State: Zip: Length of Residence:

INITIAL CLIENT QUESTIONNAIRE Financial. Name: SSN: DOB: Spouse: SSN: DOB: Address: City: State: Zip: Length of Residence: FOR OFFICE USE ONLY Chapter 7 13 Individual Joint Attorney s Fee: Filing Fee: INITIAL CLIENT QUESTIONNAIRE Financial Date: Name: SSN: DOB: Spouse: SSN: DOB: Address: City: State: Zip: County: Length of

More information

IN THE SUPERIOR COURT FOR THE COUNTY OF STATE OF GEORGIA. case No. DOMESTIC RELATIONS FINANCIAL AFFIDAVIT

IN THE SUPERIOR COURT FOR THE COUNTY OF STATE OF GEORGIA. case No. DOMESTIC RELATIONS FINANCIAL AFFIDAVIT IN THE SUPERIOR COURT FOR THE COUNTY OF STATE OF GEORGIA Plaintiff v case No. Defendant DOMESTIC RELATIONS FINANCIAL AFFIDAVIT Section 1 Affiant's Name Spouse's Name Date of Marriage Age Age Date of Separation

More information

{REMOVE THIS 1 page cover memo before sending to applicant/rp} DIVISION OF WASTE MANAGEMENT & DISTRICT PERSONNEL

{REMOVE THIS 1 page cover memo before sending to applicant/rp} DIVISION OF WASTE MANAGEMENT & DISTRICT PERSONNEL MEMORANDUM {REMOVE THIS 1 page cover memo before sending to applicant/rp} TO: FROM: SUBJECT: DIVISION OF WASTE MANAGEMENT & DISTRICT PERSONNEL OFFICE OF GENERAL COUNSEL / OFFICE OF INSPECTOR GENERAL FINANCIAL

More information

Date of Interview: NAME DURATION REASON FOR LEAVING. Marital status: Single Married Separated Divorced Widowed Common Law

Date of Interview: NAME DURATION REASON FOR LEAVING. Marital status: Single Married Separated Divorced Widowed Common Law Date of Interview: CRAWFORD SMITH & SWALLOW INC. Page 1 531 LAKE STREET, ST. CATHARINES, ONTARIO L2N 4H6 Tel: (905) 937-2100 Fax: (905) 937-7363 Website: www.crawfordss.com Email: css@crawfordss.com APPLICATION

More information

Eligibility Checklist

Eligibility Checklist Eligibility Checklist Application o Completed and signed application o Signed Authorization of Release of Information form for all adult household members (each member must sign a separate form) Household

More information

MARK S. ZUCKERBERG, P.C. ATTORNEY AT LAW

MARK S. ZUCKERBERG, P.C. ATTORNEY AT LAW LAW OFFICE OF MARK S. ZUCKERBERG, P.C. ATTORNEY AT LAW Full Legal Name: (Last, First, Middle) Spouse's Full Legal Name: (Last, First Middle) All other names used in the past 6 years: All other names used

More information

1040 US Tax Organizer

1040 US Tax Organizer 1040 US Please enter all pertinent information. If you have attached a government form for an item, check the box and do not enter a amount. WAGES, SALARIES AND TIPS Employer name: Amount 2011 Amount Attach

More information

STATEMENT OF CURRENT MONTHLY INCOME AND CALCULATION OF COMMITMENT PERIOD AND DISPOSABLE INCOME

STATEMENT OF CURRENT MONTHLY INCOME AND CALCULATION OF COMMITMENT PERIOD AND DISPOSABLE INCOME Form B22C (Chapter 13) (10/05) In re Debtor(s) Case Number: (If known) According to the calculations required by this statement: The applicable commitment period is 3 years. The applicable commitment period

More information

APPLICATION FOR FINANCIAL ASSISTANCE

APPLICATION FOR FINANCIAL ASSISTANCE APPLICATION FOR FINANCIAL ASSISTANCE Name of Student(s): Current Year(s): Current School(s): Parent and Fee Payer Details Parent(s) Father Surname: First name: Address: Mother Surname: First name: Address:

More information

Tax Return Questionnaire - 2014 Tax Year

Tax Return Questionnaire - 2014 Tax Year Print this form out, take some time to fill it out, and bring it with you when you come to the office. This will save you time and money, and help us help you more effectively. Tax Return Questionnaire

More information

SAMPLE ONLY. FACTS Grant & Aid Application For the School Year Beginning Fall 2015. Save Time Apply Online.

SAMPLE ONLY. FACTS Grant & Aid Application For the School Year Beginning Fall 2015. Save Time Apply Online. 10000028406 Save Time Apply Online. Apply online at online.factsmgt.com/aid w available in Spanish. Applying online allows your institution to view your application electronically within minutes of submission.

More information

Please note: For any return that is prepared while you wait, payment is expected at the time of completion.

Please note: For any return that is prepared while you wait, payment is expected at the time of completion. Your full name: Please answer the following questions as they relate to the year 2013. While this form is NOT required to be completed, you may be eligible for a 5% discount if this checklist is filled

More information

TAXSTAR INCOME TAX SERVICE 5-MINUTE TAX QUESTIONNAIRE

TAXSTAR INCOME TAX SERVICE 5-MINUTE TAX QUESTIONNAIRE TAXSTAR INCOME TAX SERVICE 5-MINUTE TAX QUESTIONNAIRE INSTRUCTIONS The 5-Minute Tax Questionnaire is the simple way to collect and report the information needed for us to prepare your federal and state

More information

Personal Information. Name Soc. Sec. No. Date of Birth Occupation Work Phone Taxpayer: Spouse: Street Address City State Zip

Personal Information. Name Soc. Sec. No. Date of Birth Occupation Work Phone Taxpayer: Spouse: Street Address City State Zip Paid to Taxpayer Paid to Spouse Client Tax Organizer Please complete this Organizer before your appointment. Prior year clients should use a personalized Organizer. To request a personalized Organizer,

More information

ONLY. FACTS Grant & Aid Application For the School Year Beginning Fall 2014. Save Time Apply Online.

ONLY. FACTS Grant & Aid Application For the School Year Beginning Fall 2014. Save Time Apply Online. 10000028406 Save Time Apply Online. Apply online at online.factsmgt.com/aid w available in Spanish. Applying online allows your institution to view your application electronically within minutes of submission.

More information

Williamson Medical Center Charitable Care, Prompt Payment, Uninsured/Underinsured Discount Policy

Williamson Medical Center Charitable Care, Prompt Payment, Uninsured/Underinsured Discount Policy Williamson Medical Center Charitable Care, Prompt Payment, Uninsured/Underinsured Discount Policy Effective January 1, 2013 1. Policy: Williamson Medical Center is committed to provide high quality patient

More information

Collection Information Statement for Wage Earners and Self-Employed Individuals

Collection Information Statement for Wage Earners and Self-Employed Individuals Form 433-A (Rev. December 2012) Department of the Treasury Internal Revenue Service Collection Information Statement for Wage Earners and Self-Employed Individuals Wage Earners Complete Sections 1, 2,

More information

Industry Standard Financial Statement This Statement is for use in the MARP

Industry Standard Financial Statement This Statement is for use in the MARP Industry Standard Financial Statement This Statement is for use in the MARP Section A: Account & Borrower Details Borrower Information: A1 Name A2 Mortgage Account Reference No (s) A3 Outstanding Mortgage

More information

Client Tax Organizer If you have rental property or are self-employed, please request additional organizers.

Client Tax Organizer If you have rental property or are self-employed, please request additional organizers. Client Tax Organizer If you have rental property or are self-employed, please request additional organizers. 1. Personal Information Name Soc. Sec.. Date of Birth Occupation Work Phone Taxpayer Spouse

More information

Name: Address: Email Address: Best time to contact:

Name: Address: Email Address: Best time to contact: Vehicle Application ALL SECTIONS (INCLUDING THE ATTACHED BUDGET FORM) MUST BE COMPLETED FOR YOUR APPLICATION TO BE REVIEWED CONTACT INFORMATION Name: Address: City: State: Zip: County/Township: Day Phone:

More information

Standard Financial Statement

Standard Financial Statement Standard Financial Statement 2 of 12 EBS Standard Financial Statement The information provided in the Standard Financial Statement (SFS) is vital in helping both EBS and our customers to understand their

More information

TRURO TAXATION AID COMMITTEE

TRURO TAXATION AID COMMITTEE TRURO TAXATION AID COMMITTEE Elderly and Disabled Fund -- Fiscal Year 2016 -- Guidelines and Application** **Must be submitted by Thursday, December 31, 2015 All information supplied to the Committee will

More information

Application for Mississippi Medicaid Aged, Blind and Disabled Medicaid Programs

Application for Mississippi Medicaid Aged, Blind and Disabled Medicaid Programs Application for Mississippi Medicaid Aged, Blind and Disabled Medicaid Programs This application is used for an individual, couple or child to apply for Medicaid due to age or disability. Please read each

More information

Social Security Number: Occupation: Email Address: Current Address (if not listed on W2 form or 1099 Taxpayer Name: Spouse Name: form):

Social Security Number: Occupation: Email Address: Current Address (if not listed on W2 form or 1099 Taxpayer Name: Spouse Name: form): For New Clients only - please submit with your forms and documentations TAX RETURN QUESTIONNAIRE - TAX YEAR 2014 Current Address (if not listed on W2 form or 1099 Taxpayer Name: Spouse Name: form): Phone

More information

Client Tax Organizer Worksheet

Client Tax Organizer Worksheet PAGE 1 OF 7 The asks about pertinent tax items necessary for preparing the most accurate tax return possible. Please answer all applicable questions and attach a statement when necessary for additional

More information

Name Phone Number Year THIS WORKSHEET IS PROVIDED FOR YOUR CONVENIENCE, TO HELP YOU ORGANIZE EXPENSES FOR THE FOLLOWING:

Name Phone Number Year THIS WORKSHEET IS PROVIDED FOR YOUR CONVENIENCE, TO HELP YOU ORGANIZE EXPENSES FOR THE FOLLOWING: Name Phone Number Year THIS WORKSHEET IS PROVIDED FOR YOUR CONVENIENCE, TO HELP YOU ORGANIZE EXPENSES FOR THE FOLLOWING: AUTO FOR BUSINESS OFFICE-IN-HOME CHILD CARE **AUTO EXPENSES** MAKE OF CAR/TRUCK

More information

FREE CARE APPLICATION ATTACHMENT

FREE CARE APPLICATION ATTACHMENT FREE CARE APPLICATION ATTACHMENT PLEASE REMEMBER THIS IS NOT AN INSURANCE PLAN IT IS A CHARITABLE CARE PROGRAM AND THERE IS NO ESTABLISHED FUND. THERE IS NO MONEY EXCHANGED FOR SERVICES BY ANY CMC PHYSICIAN/PRACTICE.

More information

FINANCIAL AID APPLICATION for ECE, HYC, Camp, and JCC Maccabi Games and ArtsFest

FINANCIAL AID APPLICATION for ECE, HYC, Camp, and JCC Maccabi Games and ArtsFest FINANCIAL AID APPLICATION for ECE, HYC, Camp, and JCC Maccabi Games and ArtsFest Financial Aid Checklist In order for this application to be reviewed, you must have already submitted all registration forms

More information

CLIENT INFORMATION OFFICE USE ONLY. TODAY'S DATE: Name: Any other names you may be known by: INFORMATION ABOUT YOU: SS#

CLIENT INFORMATION OFFICE USE ONLY. TODAY'S DATE: Name: Any other names you may be known by: INFORMATION ABOUT YOU: SS# CLIENT INFORMATION INFORMATION ABOUT YOU: TODAY'S DATE: Name: Any other names you may be known by: SS# Date of Birth Physical Address Mailing (if different) City State Phone #s Hm Cell Wk E-mail address

More information

ONTARIO Ontario Family Court of the Superior Court of Justice INSTRUCTIONS

ONTARIO Ontario Family Court of the Superior Court of Justice INSTRUCTIONS at ONTARIO Ontario Family Court of the Superior Court of Justice 161 Elgin Street, Ottawa, Ontario, K2P 2K1 Court File Number 04FL1234 (Name of Court) Family Law Rules, O. Reg. 114/99 (Court office address)

More information

STATEMENT OF CURRENT MONTHLY INCOME AND MEANS TEST CALCULATION FOR USE IN CHAPTER 7 ONLY

STATEMENT OF CURRENT MONTHLY INCOME AND MEANS TEST CALCULATION FOR USE IN CHAPTER 7 ONLY Form B22A (Chapter 7) (10/05) In re Debtor(s) Case Number: (If known) According to the calculations required by this statement: The presumption arises. The presumption does not arise. (Check the box as

More information

FULLER LANDAU LLP. Tax Return Questionnaire - 2014 Tax Year. Name and Address: Social Security Occupation Number:

FULLER LANDAU LLP. Tax Return Questionnaire - 2014 Tax Year. Name and Address: Social Security Occupation Number: FULLER LANDAU LLP Print this form out, take some time to fill it out, and bring it with you when you come to the office. This will save you time and money, and help us help you more effectively. Tax Return

More information

Minnesota Marriage Background Check - Birthdate Phone Number

Minnesota Marriage Background Check - Birthdate Phone Number RYAN & GRINDE, LTD. A T T O R N E Y S A T L A W James P. Ryan, Jr. 407 14 th Street NW (507) 282-8118 Paul H. Grinde Post Office Box 6667 (507) 282-2275 FAX Kristine L. Dicke Rochester, Minnesota 55903-6667

More information

Fleming, Tawfall & Company, P.C. 2015 Tax Questionnaire

Fleming, Tawfall & Company, P.C. 2015 Tax Questionnaire Fleming, Tawfall & Company, P.C. 2015 Tax Questionnaire COMPLETION OF THIS TAX QUESTIONNAIRE, ALONG WITH YOUR SIGNATURE, IS MANDATORY FOR THE 2015 TAX SEASON. Date of Spouse s Date of Name Birth Name Birth

More information

Patient Financial Assistance Program

Patient Financial Assistance Program PO Box 1810, Burlington, Vermont 05402 802-847-8000, 800-639-2719 Fax: 802-847-7618 customerservice@uvmhealth.org Dear Applicant, Thank you for choosing The University of Vermont Medical Center as your

More information

I, (full name) am am not currently employed. I am employed hours per week. I am paid weekly bi-weekly twice a month monthly.

I, (full name) am am not currently employed. I am employed hours per week. I am paid weekly bi-weekly twice a month monthly. District Court Denver Juvenile Court County, Colorado Court Address: In re: The Marriage of: Parental Responsibilities concerning: Petitioner: and Co-Petitioner/Respondent: Attorney or Party Without Attorney

More information

Date Received: Time Received: Application taken by:

Date Received: Time Received: Application taken by: Received: Time Received: Application taken by: APPLICATION FOR HOUSING Low-Income Housing Tax Credit Property This is an application for housing at: Whitney Young Manor, LP 358 Nepperhan Avenue, Management

More information

Tax Preparation Checklist

Tax Preparation Checklist Tax Preparation Checklist Being prepared for tax season could expedite your return and reduce your taxes. We have prepared a list of common items that are present with most returns. Taxpayer Checklist

More information

CLIENT INTERVIEW FORM - FAMILY LAW CLIENT IDENTIFICATION

CLIENT INTERVIEW FORM - FAMILY LAW CLIENT IDENTIFICATION CLIENT INTERVIEW FORM - FAMILY LAW Date: Lawyer: Referred By: Legal Assistant: CLIENT IDENTIFICATION Full Name: Home Address: Mailing Address: Home Phone: Work: Fax: Mobile: Email: Date of Birth: Surname

More information

APPLICATION FOR HOUSING REHABILITATION ASSISTANCE

APPLICATION FOR HOUSING REHABILITATION ASSISTANCE City of St. Petersburg HOUSING & COMMUNITY DEVELOPMENT DEPARTMENT (727) 893-7247 One Fourth Street North, Ninth Floor Municipal Services Building St. Petersburg, Florida 33701 COMPLETION OF THIS APPLICATION

More information

PERSONAL FINANCIAL ORGANIZER

PERSONAL FINANCIAL ORGANIZER PERSONAL FINANCIAL ORGANIZER SENIOR SOLUTIONS OF AMERICA, INC. www.todaysseniors.com COPYRIGHT 2007 SENIOR SOLUTIONS OF AMERICA, INC. ALL RIGHTS RESERVED. ORGANIZING YOUR PERSONAL FINANCES Are your financial

More information

Compromise Application

Compromise Application Compromise Application Before we will consider accepting less than the full amount due, we must receive all of the information requested below. Your documentation will be reviewed and verified. A Revenue

More information

Names of all Co-owners w/ Address (if different)

Names of all Co-owners w/ Address (if different) Foreclosure Prevention Intake Form I. CLIENT INFORMATION Date: Name(s) Address Home Phone Work Phone Best Times to Reach Marital Status Spouse (if any) Children (names and ages) Others in Household: II.

More information

Please be advised that monthly fees for the BEST Program are based on the state required 180 school days divided into 10 even monthly payments.

Please be advised that monthly fees for the BEST Program are based on the state required 180 school days divided into 10 even monthly payments. Brick Township Public Schools Brick Extended School Time Before and After School Care & Kindergarten Wrap Around 224 Chambers Bridge Rd - Brick, NJ 08723-732-262-2590 ext. 1531 BEST Program Families: Thank

More information

APPLICATION PERSONAL DATA

APPLICATION PERSONAL DATA APPLICATION PERSONAL DATA ORCHARD PLAZA II #220 1980 COOPER ROAD KELOWNA, BC V1Y 8K5 PHONE: 250-712-5353 FAX: 250-712-5390 www.outofdebt.ca DATE OF ASSESSMENT: BANKRUPTCY/PROPOSAL DATE OF SIGN-UP: PAYMENTS:

More information

Hallandale Beach Community Redevelopment Agency First Time Homebuyers Program

Hallandale Beach Community Redevelopment Agency First Time Homebuyers Program Hallandale Beach Community Redevelopment Agency First Time Homebuyers Program Program Overview Under the First Time Homebuyer Program, the Hallandale Beach CRA will provide up to $50,000 in assistance

More information

Application for Subsidized Housing

Application for Subsidized Housing Peel Region Upon completion, please return to: Peel Access to Housing Region of Peel - Human Services Large print applications are available upon request Disponible en français Application for Subsidized

More information

COMPLETING A BC SUPREME COURT FINANCIAL STATEMENT: WHY? HOW? WHAT HAPPENS NEXT?

COMPLETING A BC SUPREME COURT FINANCIAL STATEMENT: WHY? HOW? WHAT HAPPENS NEXT? COMPLETING A BC SUPREME COURT FINANCIAL STATEMENT: WHY? HOW? WHAT HAPPENS NEXT? WHY? Are you wondering why your lawyer has asked you to complete a BC Supreme Court Financial Statement ( FS ) when you have

More information

Request for Innocent Spouse Relief

Request for Innocent Spouse Relief Form 8857 (Rev. January 2014) Department of the Treasury Internal Revenue Service (99) Request for Innocent Spouse Relief Information about Form 8857 and its separate instructions is at www.irs.gov/form8857.

More information

2014 1040 Questionnaire

2014 1040 Questionnaire 2014 1040 Questionnaire Please check the appropriate box. Any YES answers require you to attach details and/or documentation! Personal Information YES NO Did your marital status change during the year?...

More information

2013 TAX QUESTIONAIRE & CHECKLIST PLEASE VISIT: WWW.JEFFLAINECPA.NET FOR MORE INFORMATION

2013 TAX QUESTIONAIRE & CHECKLIST PLEASE VISIT: WWW.JEFFLAINECPA.NET FOR MORE INFORMATION Dear Valued Client, 2013 TAX QUESTIONAIRE & CHECKLIST PLEASE VISIT: WWW.JEFFLAINECPA.NET FOR MORE INFORMATION Welcome and Happy New Year! As indicated last year, once again audits are up, greater emphasis

More information

GENERAL INSTRUCTIONS FOR COMPLETING NRCP 16.2 FINANCIAL DISCLOSURE FORM (Remove These Instructions Before Filing Form)

GENERAL INSTRUCTIONS FOR COMPLETING NRCP 16.2 FINANCIAL DISCLOSURE FORM (Remove These Instructions Before Filing Form) GENERAL INSTRUCTIONS FOR COMPLETING NRCP 16.2 FINANCIAL DISCLOSURE FORM (Remove These Instructions Before Filing Form) 1. Nevada Rule of Civil Procedure 16.2 requires that this Financial Disclosure Form

More information

It is our mission to provide excellence in quality and service

It is our mission to provide excellence in quality and service It is our mission to provide excellence in quality and service Date: Patient Name: MRN: For your convenience, enclosed is a Financial Assistance Application. The application is for bills acquired for services

More information

The Actors Fund of Canada provides short-term emergency financial assistance to professionals in the Canadian entertainment industry.

The Actors Fund of Canada provides short-term emergency financial assistance to professionals in the Canadian entertainment industry. Before You Start Actors Fund of Canada Application for Assistance The Actors Fund of Canada provides short-term emergency financial assistance to professionals in the Canadian entertainment industry. You

More information

Monthly Income Worksheet

Monthly Income Worksheet Monthly Income Worksheet Figure Your Monthly Income Your weekly pay X 52 12 or Your twice-a-month pay X 2 Your Monthly Take-home Pay Figure Household Members Monthly Income Weekly pay X 52 12 or Twice-a-month

More information

2011 INDIVIDUAL INCOME TAX QUESTIONNAIRE. Please explain or attach supporting documentation if you answer YES to any of the following questions.

2011 INDIVIDUAL INCOME TAX QUESTIONNAIRE. Please explain or attach supporting documentation if you answer YES to any of the following questions. INDIVIDUAL INCOME TAX QUESTIONNAIRE This questionnaire asks for pertinent information that is necessary for the preparation of your 2010 income tax returns. Your cooperation in completing the questionnaire

More information

Restructuring Worksheet

Restructuring Worksheet Page 1 Restructuring Worksheet Interviewed by: Date Interviewed: Referred by: Date Signing: Last name All given names M / F Are you known by any other names? Address Mailing address (if different from

More information

2014 INCOME TAX DATA ORGANIZER PLEASE ATTACH A VOIDED CHECK TO RECEIVE YOUR REFUND

2014 INCOME TAX DATA ORGANIZER PLEASE ATTACH A VOIDED CHECK TO RECEIVE YOUR REFUND 2014 INCOME TAX DATA ORGANIZER PLEASE ATTACH A VOIDED CHECK TO RECEIVE YOUR REFUND NAME: IF WE DO NOT HAVE THE FOLLOWING ON FILE: (1) Please provide a picture ID such as a drivers license, passport, military

More information

Please submit all of the above forms via one of the following options:

Please submit all of the above forms via one of the following options: Dear Applicant(s): Thank you for applying for a Home Equity Loan with Investors Bank. In order to begin the application process, please complete the paperwork within this Application Packet: 1. ECOA Notice

More information

Official Form B 22A2 Chapter 7 Means Test Calculation 12/14

Official Form B 22A2 Chapter 7 Means Test Calculation 12/14 Fill in this information to identify your case: Debtor 1 Debtor 2 (Spouse, if filing) United States Bankruptcy Court for the: District District of of (State) Case number (If known) Check the appropriate

More information

APPLICATION FOR GENERAL ASSISTANCE

APPLICATION FOR GENERAL ASSISTANCE Town/City of: NORTH YARMOUTH, ME APPLICATION FOR GENERAL ASSISTANCE Administrator: Please read the following to the applicant or have the applicant read it in your presence. PENALTY FOR FALSE REPRESENTATION.

More information

Client Tax Organizer

Client Tax Organizer 1/2/2008 3:37:26 PM Client Tax Organizer For the year Jan. 1-Dec. 31, 20, or other tax year beginning, 20, ending, 20. Taxpayer Last Name First Name MI Soc. Sec.. Spouse Last Name First Name MI Soc. Sec..

More information

Muret CPA, PLLC Page 1 2011 Tax Questionnaire

Muret CPA, PLLC Page 1 2011 Tax Questionnaire Muret CPA PLLC 2011 Tax Organizer Please complete and bring to your appointment, or fax to us at 918-517-3000. You can also scan and email to paul@muretcpa.com Muret CPA, PLLC Page 1 2011 Tax Questionnaire

More information

FINANCIAL PLANNING QUESTIONNAIRE

FINANCIAL PLANNING QUESTIONNAIRE FINANCIAL PLANNING QUESTIONNAIRE General Information Title Mr. Ms. Mrs. First Name Middle Name Last Name Birth date MM/DD/YY Sex Smoker Y/N S.I.N. # Home Address: City: Province Postal Code: Home Phone:

More information

Request for Reconsideration Form (Level 1)

Request for Reconsideration Form (Level 1) Request for Reconsideration Form (Level 1) Page A Information After you have submitted an Application for Financial Assistance, you may find that your situation has changed or you want to have your Application

More information

Healthy Smiles Ontario Program Application Form A

Healthy Smiles Ontario Program Application Form A Ministry of Health and Long-Term Care Healthy Smiles Ontario Program Application Form A Program Information The Healthy Smiles Ontario Program is an Ontario government-funded basic dental program providing

More information

The Kaiser Permanente Bridge Program Application

The Kaiser Permanente Bridge Program Application The Kaiser Permanente Bridge Program Application Kaiser Foundation Health Plan of Georgia, Inc. APP/CB-080500 11/08 Instructions ISTRUCTIOS: Please print clearly using a blue or black ink pen. If the question

More information

FAX: Atty. Reg. #: Division Courtroom SWORN FINANCIAL STATEMENT

FAX: Atty. Reg. #: Division Courtroom SWORN FINANCIAL STATEMENT District Court Denver Juvenile Court County, Colorado Family Court 333 Monroe St Court address 222 Newtown, PA 19323 In re: The Marriage of: Parental Responsibilities concerning: Petitioner: George J Jones

More information

STATE OF VERMONT. Defendant Name V. FINANCIAL AFFIDAVIT (813A) Other: Street Address (if different from Street Address)

STATE OF VERMONT. Defendant Name V. FINANCIAL AFFIDAVIT (813A) Other: Street Address (if different from Street Address) STATE OF VERMONT SUPERIOR COURT Unit Plaintiff Name DOB FAMILY DIVISION Docket No. Defendant Name DOB V. FINANCIAL AFFIDAVIT (813A) I am: Plaintiff Defendant Other: Name Street Address (if different from

More information

If this is a HAFA short sale: Please note that contributions are not be allowed in a HAFA short sale from the buyer; seller or agents.

If this is a HAFA short sale: Please note that contributions are not be allowed in a HAFA short sale from the buyer; seller or agents. All short sales are processed on Equator.com. Agents must be registered for short sales to be assigned to them. Required Document Checklist must be complete (all documents uploaded into Equator and labeled

More information

Personal Information - Client - Page 1. Employment. Education. Military Service. Children & Dependents

Personal Information - Client - Page 1. Employment. Education. Military Service. Children & Dependents Personal Information - Client - Page Date Mr. Mrs. Ms. First Name M.I. Last Name Birth Date Age S.S. Number Street Address City/Town Home Phone Cell Phone State/Zip Fax Email Address Employment Occupation

More information

Complimentary Financial Planner

Complimentary Financial Planner Complimentary Financial Planner Creating Wealth Since 1922 PERSONAL INFORMATION Name Social Security Number Date of Birth Home Street Address You Your Spouse City, State, Zip Home Telephone Marital Status

More information

One Affordable Homeownership Unit - Adaptable Unit with Accessible Features

One Affordable Homeownership Unit - Adaptable Unit with Accessible Features One Affordable Homeownership Unit - Adaptable Unit with Accessible Features Located at 100 Pacific Street near Central Square, this unit will be available, through the City s Inclusionary Housing Program,

More information