CERTIFICATION OF UNFILED TAX RETURNS
This form is only to be completed in the event that a student, parent, or student’s spouse did not file a federal tax return for 2011. If you did file a return please provide us with a copy in place of this form.
Student’s Name _______________________________________________________SS#__________________________
The following statements are to be completed by (i.e. who did not file taxes):
_____ Student (You must sign before a Notary Public; parent’s signature is not required)
_____ Student and spouse (Both student & spouse must sign before a Notary Public)
_____ Parent of student (Both student and parent must sign before a Notary Public)
PLEASE CHOOSE ONE OF THE FOLLOWING
I (we) did not and will not file a Federal Income Tax Return (IRS Form 1040, 1040A, or 1040EZ) for 2010. I (we) will, if requested, provide official documentation from the Internal Revenue Service (IRS) to this effect. The reason for not filing a Federal Income Tax Return was:
_____ I (we) received no taxable and/or un-taxable income for tax year 2011.
_____ I (we) received taxable and/or un-taxable income, however, taxable and/or un-taxable income received was less than the amount required for filing a tax return. My (our) total income (taxable and/or un-taxable) for 2011 was $_____________ from the following sources (if earned from a job, please provide a W2):
On this day personally appeared before me___________ and______________, Parent(s), to me
Known to be individual(s) described in and who executed the foregoing instrument, and acknowledged that s/he signed the same as his/her free and voluntary act and deed for the uses and purposes therein mentioned.
GIVEN under my hand and official seal this ______day of_______, 201_