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NON-FILING OF U.S. INCOME TAX RETURN
Directions:
Dependent Students: If you are a dependent student and did not file a 2020 federal income tax return, you and your parent(s) must complete this entire form.
Independent Students: If you are an independent student and did not file a 2020 federal income tax return, 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 |
| | |(Last four digits only) |
| | | |
|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 did not file and were not required to file a federal income tax return this year. 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 this year. If you filed a federal income tax return this year, do not file out Section A of this form. Instead, send a |
|photocopy of your signed federal tax return from this year to JVS. |
| |
|Student’s Income |
|Employer’s name or source of income |2020 Earnings |
| | |
| | |
|Spousal Income |
|Employer’s name or source of income |2020 Earnings |
| | |
| | |
|□ SECTION B. Non-filing of U.S. income tax return for parents |
|Complete this section if your parent(s) did not file and were not required to file a 2020 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) filed a 2020 federal income tax return, do not file out Section B of this form. Instead, send a photocopy of your |
|parent(s) signed 2020 federal tax return to JVS. |
|Parental Income |
|Employer’s name or source of income |Name of Parent |2020 Earnings |
| | | |
| | | |
|□ SECTION C. Certification |
|Student statement: I certify that federal law did not require me to file a 2020 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/we certify that federal law did not require me/us to file a 2019 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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