Parent Tax Non Filing Statement Yale University

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Parent Tax Non Filing Statement Yale University Powered By Docstoc
					           Yale University                            Student Financial Services   Phone: (203) 432-2700
                                                      P.O. Box 208288              Fax:   (203) 777-6100
           Student Financial Services                 New Haven, CT 06520-8288
           http://www.yale.edu/financialaid



                     20     -201 Parent Tax Non-Filing Statement

                                         Student Information
Student’s Name: ________________________________________________________________

Yale I.D. Number: __________________________ Date of Birth: ________________________




                                          Parent Information
Parent Completing this form:        Mother               Father               Both Mother and Father

Mother’s Name: ______________________________________ Social Security#: ____________

Father’s Name: ______________________________________ Social Security #: ____________




                                      2011 Income Information
                             Source of Income                                          Amount
Wages (If you worked in 20 , you must attach your W2 form(s) to this form          $
Interest and Dividend Income                                                   $
Child Support                                                                  $
Social Security Benefits                                                       $
Welfare Benefits                                                               $
Other Untaxed Income: (Indicate Source: _______________________)               $
Comments:




                                              Certification
By signing this form, I certify that I did not and am not required to file a U.S., Puerto Rican,
Canadian, or foreign federal tax return. In addition, I certify that all of the information reported on
this form is complete and correct.
Mother’s Signature: __________________________________________________ Date: ______

Father’s Signature: ___________________________________________________ Date: ______

				
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