Income Affidavit For Pension
I, [Your Name], being duly sworn, depose and state as follows:
Personal Information:
Full Name: [Your Name]
Date of Birth: [Birthdate]
Social Security Number: [SSN]
Address: [Your Address]
Contact Information: [Your Email]
Employment and Income:
Current Employer: [Your Company Name]
Occupation/Position: [Your Title]
Monthly Gross Income: [Your Income]
Pension Benefits:
Pension Provider: [Pension Provider Name]
Type of Pension: [Pension Type]
Monthly Pension Benefit: [Amount]
Additional Financial Information:
ASSETS:
Savings Account: [Amount]
Investment Portfolio: [Amount]
Real Estate: House valued at [Amount]
LIABILITIES:
Mortgage on Real Estate: [Amount]
I certify under penalty of perjury that the foregoing is true and correct to the best of my knowledge, information, and belief.
[Your Name]
Sworn to and subscribed before me on this [Date] day of [Month] [Year].
[Notary Public Name]
Notary Public, State of [Your State]
Commission Number: [Commission Number]
Date Commission Expires: [Date]
[Notary Seal, if applicable]
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