Alaska Permanent Dividend Fund Tax Form - PDF

Document Sample
Alaska Permanent Dividend Fund Tax Form - PDF Powered By Docstoc
					Alaska Permanent Fund Dividend                                                                                                                                  08155
2009 Audit Form
socIaL securIty NumBer                                                                  Date oF BIrth
FIrst Name                                                   m.I. Last Name                              Month         Day     Year


I certify that the information I am supplying on and with this form is true. I understand that a false statement made on or with this form will subject me to
the same penalties disclosed on my original application.
(Your signature is required)                                                                                          Date


 Questions 1-3 intentionally excluded.
4. A. Are you currently absent from or living outside of Alaska today?                           yes     No If NO, go to Question 5A
     B. If YES, are you returning to Alaska to remain indefinitely?                     yes              No
     C. If YES, when did you depart Alaska? AND when are you returning to remain indefinitely?


           Month                 Day Year                       Month        Day          Year
5. A. Are you married?                yes        No           If NO, go to question 6
     B. If you are married, is your spouse applying for this year's dividend?                      Yes     No If NO, attach an explanation
6. A. Have you maintained your principal home or stored the majority of your
        household belongings in Alaska continuously since December 31, 2007?                       Yes     No
     B. Do you        Own            Lease or Rent      Live with parents  Store        Other (attach explanation)
     C. Physical address of home or storage: _______________________________________________________________________________________________
                                            CITY:______________________________________ STATE: _________________ ZIP CODE: _________________
7. At any time since DECEMBER 31, 2007 have you:
a. Maintained your principal home outside of Alaska?                                                             a.      Yes   No
     Did you:        Own          Lease or Rent   Live with parents   Other (attach explanation)
         Address
         City, State, Zip Code
                                                                                                                                       State
B. Claimed residency in another state or country in your employment records, including leave and earn- B.                Yes   No
     ings statements if you are a member of the U.S. Armed Forces?
                                                                                                                                       Vehicle Plate #
C. While living in Alaska, registered a vehicle as the owner or co-owner and claimed a non-resident Alaska C.            Yes   No
     motor vehicle tax exemption?                                                                                                      State
D. Accepted full-time permanent employment in another state or country?                                          D.      Yes   No
                                                                                                                                       State
E. Filed or you will be required to file a 2008 resident or part-year resident income, personal property, or E.          Yes   No
     excise tax return in another state or country? If YES, attach a copy of the return.                                               State               County
F.   Claimed a homestead property tax exemption in another state or country? If YES, attach an explana-          F.      Yes   No
     tion and copy of the homestead exemption law.                                                                                     State                  Date
G. Applied for or received a student loan from another state or country? If YES, attach a copy of                G.      Yes   No
     the application.
     If you received a federal Stafford, Sallie Mae, Nellie Mae, TERI or Bank loan, answer NO.                                         State                  Date

H. Disclosed in a court proceeding or affidavit that you are a resident of another state or country?             H.      Yes   No
     If YES, attach a copy of the affidavit or documents.                                                                              State                  Date

I.   Executed a will which described residency in another state or country? If YES, attach a copy                I.      Yes   No
     of the will.                                                                                                                      State                  Date

L. Moved from Alaska and claimed or will claim moving expenses as a deduction on your 2008 federal               L.      Yes   No
     income tax return? If YES, attach a copy of the return.                                                                           State                  Date

M. Registered to vote in another state or country?                                                               M.      Yes   No
                                                                                                                                       State                  Date

N. Voted in a local or state election in another state or country?                                               N.      Yes   No
                                                                                                                                       State                  Date
O. Purchased a resident hunting, fishing or trapping license in another state or country? If YES,                O.      Yes   No
     attach a copy of that state’s or country’s license regulations.                                                                   State                  Date

P.   Filed for divorce, dissolution or legal separation in another state or country? If YES, attach              P.      Yes   No
     a copy of documents.                                                                                                              State                  Date

Q. Obtained benefits as a result of establishing or maintaining a claim of residency in another state or         Q.      Yes   No
     country? If YES, attach an explanation.                                                                                           State             Vehicle Plate #

R. Maintained a vehicle registered in another state or country or obtained or renewed another                    R.      Yes   No
     state's or country's vehicle registration?                                                                                        State               License #

S. Maintained a driver’s license in another state or country or obtained or renewed another state’s or           S.      Yes   No
     country’s driver’s license?



08155                                                                     www.pfd.alaska.gov

				
DOCUMENT INFO
Description: Alaska Permanent Dividend Fund Tax Form document sample