K. Stoetzner, Grand Valley State University, 1 Campus Dr, 130 LOH, Allendale MI 40401 616 331 3898
NOTE: Please complete everything in Yellow!
You must REALLY count all of the days that you were in the US.
If you only have to complete this form, please mail it to: Department of the Treasury, Internal
Revenue Service Center, Austin, TX 73301-0215
If you have other forms- please include this one with your 1040NR EZ