Economic Impact Payment for Non-filers (EIP-NF)
Department of Revenue and Taxation
Economic Impact Payment for Non-filers (EIP-NF)
Do not file this form if: - You have already filed a 2018 and/or 2019 Guam income tax return. - Your 2019 gross income exceeded $12,200 ($24,400 for a married couple) or other reasons require you to file a 2019 Guam income tax return. - You were married at the end of 2019 and are not submitting information here with your spouse. - You were not a U.S. citizen or U.S. permanent resident in 2019.
I. Filing Status
Single
Married filing jointly
(If there is one adult on this form, select Single. If there are two adults, select Married fiing jointly.
II. Personal Info a. Your first name and middle initial
Last Name
Your social security number
b. If joint return, spouse's first name and middle initial Last Name
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Spouse's social security number
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c. Home address (number and street). If you have a P.O. Box, enter P.O. box only if no mail is delivered to your home
Apt. no
d. City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below.
e. Foreign country name
Foreign province/state/country Foreign postal code
f. Someone can claim:
You as a dependent
Your spouse as a dependent
If someone else claimed you on their tax return you will not be eligible for the Economic Impact Payment
III. Dependents
First Name
Middle Initial
Last Name
Social Security number or Adoption Taxpayer Identification Number
Date of Birth (Month/Year)
Relationship to you
a.
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b.
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c.
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d.
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e.
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f.
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For additional dependents, include a statement showing required information
IV. Indicate the following
a.
You (and/or your spouse if applicable) receive Social Security, Railroad Retirement, or SSDI benefits.
b.
You (and/or your spouse if applicable) receive veterans disability compensation, a pension, or survivor benefits from
the Department of Veterans Affairs.
c.
Your (and your spouse if applicable) income level does not require you to file a Guam income tax return for 2018 and
2019.
V. Enter your GROSS INCOME here:
$
This includes all income you receive in the form of money, goods, property, and services that is not exempt from tax.
VI. Sign Under penalties of perjury, I declare that I have examined this EIP-NF form, and to the best of my knowledge and Here belief, they are true, correct and complete.
Your Signature
Date
Spouse's Signature. If a joint return, both must sign
Date
Phone no.:
Email address:
Form EIP-NF (05/2020)
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