Brandeis University 2015 Tax Year r’s Statement Student Non-Tax File

Brandeis University
2015 Tax Year
Student Non-Tax Filer’s Statement
This statement should be completed if you are a U.S. citizen, eligible non-citizen, and/or U.S. resident and will
not file and are not required to file a 2015 U.S. federal tax return.
List below all of the sources and amounts of money received from January 1, 2015 through December 31,
2015. Include untaxed income (e.g., AFDC, SSI, military living allowance) and earnings not reported on a
federal income tax return. Please include supporting documentation for all income sources listed below. You
must attach copies of any W-2 form(s) and/or 1099 form(s) received in 2015.
Student Information – Please Print
Student’s Name:
_ Social Security Number:
Spouse’s Name:
(if applicable)
Social Security Number:
2015 Income Information: 1/01/15 – 12/31/15
Source of Income
Total: $
By signing this form, I certify that I did not and am not required to file a 2015 U.S. federal tax return. In addition,
I certify that all of the information reported on this form is complete and correct.
Student’s Signature:
_ Date:
Spouse’s Signature:
(if applicable)
To view your IDOC requirements or instructions, go to