Transcription of If you have zero income, please complete this form and return …
1 4 Barrell Court PO Box 2097. Concord, NH 03302-2097. If you have zero income, please complete this form and return it to us with your Economic Hardship Deferment application or your forbearance request. First Name Last Name Street Address City State Zip Code Social Security or Account Number Home Telephone Cell Phone Email address Self-Certification Statement: To: Granite State Management & Resources I, the undersigned, certify that I do not have any income due to unemployment, incarceration, disability, or due to a temporary leave of absence from work.
2 Borrower Signature_____ Date_____. For office use only: GSM&R Staff Approval_____ Date_____. PO Box 2097 | Concord, NH 03302-2097 | | |
