Fillable Form 76205: TAX CHECK-IN INFORMATION FOR FOREIGN VISITORS

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Form 76205: TAX CHECK-IN INFORMATION FOR FOREIGN VISITORS

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The Form 76205: TAX CHECK-IN INFORMATION FOR FOREIGN VISITORS form is 3 pages long and contains:

  • 1 signature
  • 36 check-boxes
  • 81 other fields

Country of origin: US
File type: PDF

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Initials ______
TAX CHECK-IN INFORMATION FOR FOREIGN VISITORS
NEW REVISED VISA CHANGE
(complete all sections) (complete name, revised sections, and sign) (complete name, sections 2 & 3, and sign)
SECTION 1
Visitor’s Name
Surname (Family Name) Given Name Middle Name
EMPL ID Department
U.S. Social Security or Taxpayer Identification Number
(attach copy)
Date of birth Marital status Sex M F
(MM/DD/YY)
Is spouse present in the United States? Y N Is spouse working in the U.S? Y N
Number of other dependents present in the United States
Local residence address information (required)
Local street address in the United States
City State ZIP code
Home phone number Work phone number
Foreign residence address information (personal, family, or friend)
Country Postal Code
State, Province, or Region
City or Town
Precinct or Subdivision
Street Address/House Number
Country of citizenship Country of passport
Passport number Expiration date
(attach copy of information pages) (MM/DD/YY)
Country of tax residence
Did tax residency end? Y N If Yes, date
(MM/DD/YY)
Hand delivery or mail 1112 Dallas
Dr., Suite 4000 Denton, TX
76205
Email: payroll@untsystem.edu
Fax: 940.369.5
1112 Dallas Dr., Ste 4000
Woodhill Square
Denton, TX 76205
Ph: 940.369.5500
Web: untsystem.edu
SECTION 2
Immigration Status Current visa number
Current I-94 number
F-1or J-1 Student F-1 or J-1 Student (on Practical Training)
(attach front and back copies of I-20 or DS-2019, and I-688B or I-766)
Name of institution where enrolled
&KHFN one: Undergraduate Masters Doctoral
Other
J-1 Exchange Visitor (Check Subtype From List Below)
(attach copy of DS-2019)
02 Trainee 06 Alien Physician
03 Teacher 08 Research Scholar
04 Professor
J-2 Dependent of J-1 Exchange Visitor
(attach copy of DS -2019 and front and back copy of EAD)
H-1B Temporary Employee (attach copy of I-797)
O-1 Alien of Extraordinary Ability (attach copy of I-797)
B-1/B-2 Visitor for Business (attach copy of passport stamp)
Status Adjustment Applicant (attach front and back copy of I-688 or I-766)
Lawful Temporary Resident (attach front and back copy of I-688 or I-766)
Conditional Permanent Resident
(attach front and back copy of I-551 card, or copy of passport stamp)
Other
SECTION 3
Primary Activity of Visit (Please Check One)
Studying in a Degree Program ________ Conducting Research ________
Studying in a Non-Degree Program ________ Demonstrating Special Skills ________
Teaching ________ Clinical Activities ________
Lecturing ________ Temporary Employment ________
Observing ________ Here with Spouse ________
Consulting ________
Other (Please specify)
Anticipated date of departure from United States (MM/DD/YY)
Hand delivery or mail 1112 Dallas
Dr., Suite 4000 Denton, TX
76205
Email: payroll@untsystem.edu
Fax: 940.369.5
SECTION 4
Visa Immigration Status
Please list ALL visits to the United States and visas held, and ALL changes of immigration status. Indicate
whether any tax treaty benefits were claimed.
From (MM/DD/YY) To (MM/DD/YY) Visa Type Student? Treaty Claimed?
__________________ __________________ __________________ ________ ____________
__________________ __________________ __________________ ________ ____________
__________________ __________________ __________________ ________ ____________
__________________ __________________ __________________ ________ ____________
__________________ __________________ __________________ ________ ____________
__________________ __________________ __________________ ________ ____________
__________________ __________________ __________________ ________ ____________
__________________ __________________ __________________ ________ ____________
__________________ __________________ __________________ ________ ____________
Please attach copies of the information pages and visa pages from the passport.
SECTION 5
Tax Information
Taxation is a private matter between each individual and the United States Government. Any exemption
from income tax based on tax treaty is usually limited to two years or less. It is the Visitor’s responsibility
to determine that deductions for income tax and social security tax are correct for each individual situation.
Questions should be directed to the Internal Revenue Service, 1-800-829-1040.
Each Visitor must file a tax form with the IRS each year by April 15.
It is the Visitor’s responsibility to inform the International Office of any changes in employment or
immigration status. A change in visa classification or in the nature of a job could change the tax liability
status.
I certify that I have read and understand the foregoing and that it is correct.
Signature Date
1112 Dallas Dr., Ste 4000
Woodhill Square
Denton, TX 76205
Ph: 940.369.5500
Web: untsystem.edu
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Form 76205: TAX CHECK-IN INFORMATION FOR FOREIGN VISITORS

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Completed 18 March 2022

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