2014 Tax Year

Student Non-Tax Filers 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 2014 U.S. federal tax return.
List below all of the sources and amounts of money received from January 1, 2014 through December 31,
2014. 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 2014.

Student Information Please Print

Students Name: ___________________________________ Social Security Number: ___________________
Spouses Name: ___________________________________ Social Security Number: ___________________
(if applicable)

2014 Income Information: 1/01/14 12/31/14

Source of Income

Amount

$
$
$
$
$
$
$
$
$
Total: $___________________________

Certification
By signing this form, I certify that I did not and am not required to file a 2014 U.S. federal tax return. In addition,
I certify that all of the information reported on this form is complete and correct.
Students Signature: ______________________________________ Date: __________________________
Spouses Signature: ______________________________________ Date: __________________________
(if applicable)

To view your IDOC requirements or instructions, go to https://idoc.collegeboard.com.

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