2018-2019 Independent Verification of 2016 Income Information for
Student Nontax Filers
Student Name________________________________
CID____________________
The instructions and certifications below apply to the student and spouse; if the student is
married. Complete this section if the student and/or spouse will not file and are not required to
file a 2016 income tax return with the IRS.
Check all boxes that apply:
I (the student) did not file an income tax return and was not employed in 2016.
Provide a letter of non-filing from the IRS. See instructions on reverse side.
I (the student) did not file and was not required to file, but was employed in 2016.
Provide all W-2s or an IRS Wage & Income Transcript. Please complete the table below listing each
source of income. Provide a letter of non-filing from the IRS. See instructions on reverse side.
My spouse did not file an income tax return and was not employed in 2016. Provide a
letter of non-filing from the IRS. See instructions on reverse side.
My spouse did not file and was not required to file, but was employed in 2016. Provide
all W-2s or an IRS Wage & Income Transcript. Please complete the table below listing each source
of income. Provide a letter of non-filing from the IRS. See instructions on reverse side.
Employer’s Name
IRS W-2
Provided?
Annual Amount
Earned in 2016
(Example) ABC’s Auto Body Shop
Yes
$4,500.00
Total Amount of Income Earned From Work
$
Provide documentation from the IRS dated on or after October 1, 2017 that indicates a 2016
IRS income tax return was not filed with the IRS.
___________________________________________
Student’s Signature (Required)
________________________
Date
Instructions to Obtain a Letter of Non-Filing
Go to www.irs.gov/individuals/get-transcript
Click on Get Transcript by Mail
- You will need your SSN or Individual Tax Identification Number (ITIN), date of
birth, and mailing address from your latest tax return
- Once information is entered request a Return Transcript for 2016.
Telephone Request 1-800-908-9946
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome