Office of Student Fiscal Affairs

PARENT NON-FILER CERTIFICATION
(Parent(s) Stepmother, Stepfather, or Guardian)

Note: Whether you filed a tax return or not, you must submit copies of all W-2 and/or 1099 forms received for the 2017 tax year.

Parent(s) who will not file a 2017 Federal Income Tax Return must complete this form.

Please complete ALL sections of the form. Enter “0” if you did not receive any taxable and/or nontaxable income.

Contact Information

Today's Date * +

E-mail *

1. Last Name *

First Name *

Middle Initial

4. Current Mailing Address *

Apt # or P.O. Box *

City *

State *

Zip Code *

5. Permanent Mailing Address *

Apt # or P.O. Box *

City *

State *

Zip Code *

Federal Tax Information

The information below pertains to (check one): *

I (we) did not and will not file a 2017 Federal Income Tax Return, IRS Form 1040, 1040A, or 1040EZ for the following reasons (check one):

Received no taxable income

Taxable income received was less that the amount required for filing a tax return (list amount of taxable income): Taxable income received was less that the amount required for filing a tax return (list amount of taxable income):

My (our) total income (taxable and/or nontaxable) for 2017 (January 1 - December 31) was

Source of income

Signature *