Filing a Zero Income Tax Return by qov12865

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									                           NON-FILING OF U.S. INCOME TAX RETURN
                                  2010-2011 ACADEMIC YEAR

Directions:
Dependent Students: If you are a dependent student, you and your parent(s) must complete this entire
form.
Independent Students: If you are an independent student, fill out the student and spouse (if applicable)
portion of Section A and sign Section C.

STUDENT INFORMATION
Name (Last, First, Middle Initial)    Birth Date                             Social Security Number



PARENT INFORMATION
Mother/Stepmother Name (if applicable)

Father/Stepfather Name (if applicable)



□    SECTION A. Non-filing of U.S. income tax return for student/spouse
Complete this section if you and/or your spouse will not be filing and are not required to file a 2009 federal
income tax return. Please list all forms of income, including wages, earnings on savings and investments, child
support, unemployment, welfare, and other income you and/or your spouse received in 2009. If you will be filing a
2009 federal income tax return, do not file out Section A of this form. Instead, send a photocopy of your signed
2009 federal tax return to JVS. Consult your tax advisor if you have any questions about whether you and/or your
parent(s) are required to file a 2009 federal income tax return.
Student’s Income
Employer’s name or source of income                       2009 Earnings




Spousal Income
Employer’s name or source of income                       2009 Earnings
□    SECTION B. Non-filing of U.S. income tax return for parents
Complete this section if your parent(s) will not be filing and are not required to file a 2009 federal income tax
return. Please list all forms of income, including wages, earnings on savings and investments, child support,
unemployment, welfare, and other income used to support your family. If your parent(s) will be filing a 2009
federal income tax return, do not file out Section B of this form. Instead, send a photocopy of your parent(s)
signed 2009 federal tax return to JVS. Consult your tax advisor if you have any questions about whether you and/or your
parent(s) are required to file a 2009 federal income tax return.
Parental Income
Employer’s name or source of income            Name of Parent                        2009 Earnings




Note: If you report ZERO income on this form, please explain in writing below how you supported
yourself/family in 2009, and how you plan to support yourself/family in 2010. Submit an itemized list of
your expenses for rent, food, utilities, clothing, etc. and how those expenses will be paid for.




□    SECTION C. Certification
Student statement: I certify that federal law does not require me to file a 2009 federal income tax return. I certify
that all of the information on this form is true and correct to the best of my knowledge.
Student Signature                                            Date Signed


Parental statement: I am/we certify that federal law does not require me/us to file a 2009 federal income tax
return. I/we certify that all of the information on this form is true and correct to the best of my/our knowledge.
Mother/Stepmother Signature                                  Date Signed


Father/Stepfather Signature                                  Date Signed

								
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