FA-Confirmation of Pension and Annuity Rollover Tax Year 2023

2025-26 Confirmation of Pension and Annuity Rollover Tax Year 2023

Financial Aid Office: Phone (252) 291-1195 Fax (252) 243-7148 financial_aid@wilsoncc.edu
Student Name

First NameLast Name
Student ID
The Department of Education had identified a non-zero amount transferred into the untaxed pension or IRA distribution field reported on your FAFSA. The reported rollover amount has been subtracted from the IRA or Pension distribution that was transferred from the IRS. The result was used in the calculation of your expected family contribution (EFC).
Please complete the section below to certify that this information is correct.

Yes, I certify that the untaxed pension or IRA distribution transferred from the IRS contained a rollover.No, I certify that the untaxed pension or IRA distribution transferred from the IRS did NOT contain a rollover.
Certifications and Signatures

Your signature certifies that you have read and understand each statement and all information reported on this form is complete and correct.
Student's Signature

Clear
Date

MonthDayYear
Date
Parent's Signature (if student is dependent)

Clear
Date

MonthDayYear
Date
WARNING : If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Should be Empty:

2025-26 Confirmation of Pension and Annuity Rollover Tax Year 2023