Fillable NON-FILER STATEMENT If more space is needed, attach (Community College of Allegheny County)

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NON-FILER STATEMENT If more space is needed, attach (Community College of Allegheny County)

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COMMUNITY COLLEGE OF ALLEGHENY COUNTY
CCAC–Allegheny Campus
808 Ridge Avenue
Pittsburgh, PA 15212
Ph: 412.237.2589
Fax: 412.237.3171
CCAC–Boyce Campus
595 BEatty Road
Pittsburgh, PA 15146
Ph: 724.325.6602
Fax: 412.237.3173
CCAC–North Campus
8701 Perry Highway
Pittsburgh, PA 15237
Ph: 412.369.3656
Fax: 412.237.3175
CCAC–South Campus
1750 Clairton Road
West Mifin, PA 15122
Ph: 412.469.6241
Fax: 412.237.3177
NON-FILER STATEMENT
In the space below indicate how you have attempted to obtain verication of your ling status from the IRS and have been
unsuccessful in your attempts. Please be as specic as possible and attach any proof of such attempts to this document.
If more space is needed, attach a separate page with the student’s name and ID number/Social Security Number at the top
Student’s Last Name Student’s First Name Student’s M.I. CCAC ID #
Student Signature Date Parent Signature (if parent is non-filer) Date
Notications of nondiscrimination and contact information can be found at ccac.edu, search keywords “notications of nondiscrimination.”
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NON-FILER STATEMENT If more space is needed, attach (Community College of Allegheny County)

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Completed 4 February 2021

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