Use this form in order to evaluate your treaty/tax benefits.


Submission Instructions:  Tax Compliance Office, 377 Pine Tree Road, Ithaca, NY 14850 or Fax to: 607-255-3198.  Include copies of both sides of your I-94 Form " Arrival and Departure Record", ( a small white card inside your passport.)  Your visa From Your Passport and Form I-20 or IAP66/DS2019.

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Help Topics and Completion Guidelines

1. Name: List full name.
   
   
2. Fed ID #/Social Security Number. Enter US Social Security Number issued by the US Social Security Administration not your ID number. Do not list numbers not assigned by the United States Social Security Administration, i.e. Canadian Social Insurance Number. All employees must have a US Social Security Number in order to work.  If none, enter your ITIN issued by the IRS.
   
   
3. Local Street Address: List your local US address.
   
   
4. Residence: List your non-US Address.
   
   
5. Country of Citizenship.
   
   
6. Country that Issued Passport: List Country in which you where issued your passport, not the country where it was issued.
   
   
7. Passport #: Enter your passport number.
   
   
8. Visa #: Enter your visa number.
   
   
9. Immigration Status: Check Yes or No. If Yes, complete the above form for the time you were present in the United States. Approximate if you don't know.
   
   
10. Immigration Status: Check the type of immigration status that you currently hold. If you check US Immigrant / Permanent Resident, holder of a "green" card, you may proceed to the bottom of the form. Sign and date.
    
    
11. Immigration Status for J-1: Check the appropriate J-1 subtype.
    
    
12. Actual Primary Activity: Check one activity.
    
    
13. Actual Entry Date into the United States: Must include month, day and year. Approximate if you don't know.
    
    
14. Start Date: Must include month, day and year.  Approximate if you don't know.
    
    
15. End Date: Must include month, day and year.  Approximate if you don't know.
    
    
16. Occupation: Describe in general the service you will perform.
    
    
17. Type of student: Check the appropriate box.
    
    
18. Is your spouse in the USA?: Check the appropriate box. Give number of other dependents in the USA?
    
    
19. Tax Residence is where you last paid taxes as a resident and can be different form legal residence.  Do not include the USA.
    
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