Form 08155 - Audit - Alaska Permanent Fund Dividend - 2009
ADVERTISEMENT
108155
Alaska Permanent Fund Dividend
2009 Audit Form
socIaL securIty NumBer
Date oF BIrth
Month
Day
Year
FIrst Name
m.I. Last Name
I certify that the information I am supplying on and with this form is true. I understand that a false statement made on or with this form will subject me to
the same penalties disclosed on my original application.
(Your signature is required)
Date
Questions 1-3 intentionally excluded.
yes
No If NO, go to Question 5A
4
A
. Are you currently absent from or living outside of Alaska today?
.
B.
yes
No
If YES, are you returning to Alaska to remain indefinitely?
C
. If YES, when did you depart Alaska? AND when are you returning to remain indefinitely?
Month
Day
Year
Month
Day
Year
5
A
.
. Are you married?
If NO, go to question 6
yes
No
B
Yes
No
. If you are married, is your spouse applying for this year's dividend?
If NO, attach an explanation
6
A
.
. Have you maintained your principal home or stored the majority of your
Yes
No
household belongings in Alaska continuously since December 31, 2007?
B
Own
. Do you
Lease or Rent
Live with parents
Other (attach explanation)
Store
C
. Physical address of home or storage: _______________________________________________________________________________________________
______________________________________
_________________
_________________
CITY:
STATE:
ZIP CODE:
.
7
At any time since DECEMBER 31, 2007 have you:
a.
Maintained your principal home outside of Alaska?
a.
Yes
No
Did you:
Own
Lease or Rent
Live with parents
Other (attach explanation)
Address
City, State, Zip Code
State
B.
B.
Claimed residency in another state or country in your employment records, including leave and earn-
Yes
No
ings statements if you are a member of the U.S. Armed Forces?
Vehicle Plate #
C.
C.
While living in Alaska, registered a vehicle as the owner or co-owner and claimed a non-resident Alaska
Yes
No
motor vehicle tax exemption?
State
D.
D.
Yes
No
Accepted full-time permanent employment in another state or country?
State
E.
Yes
No
E.
Filed or you will be required to file a 2008 resident or part-year resident income, personal property, or
excise tax return in another state or country? If YES, attach a copy of the return.
State
County
F.
F.
Claimed a homestead property tax exemption in another state or country? If YES, attach an explana-
Yes
No
tion and copy of the homestead exemption law.
Date
State
G.
G.
Yes
No
Applied for or received a student loan from another state or country? If YES, attach a copy of
the application.
If you received a federal Stafford, Sallie Mae, Nellie Mae, TERI or Bank loan, answer NO.
State
Date
H.
H.
Disclosed in a court proceeding or affidavit that you are a resident of another state or country?
Yes
No
Date
If YES, attach a copy of the affidavit or documents.
State
I.
I.
Executed a will which described residency in another state or country? If YES, attach a copy
Yes
No
of the will.
State
Date
L.
L.
Moved from Alaska and claimed or will claim moving expenses as a deduction on your 2008 federal
Yes
No
Date
income tax return? If YES, attach a copy of the return.
State
M.
M.
Registered to vote in another state or country?
Yes
No
Date
State
N.
N.
Yes
No
Voted in a local or state election in another state or country?
State
Date
O.
Yes
No
O.
Purchased a resident hunting, fishing or trapping license in another state or country? If YES,
attach a copy of that state’s or country’s license regulations.
Date
State
P.
P.
Filed for divorce, dissolution or legal separation in another state or country? If YES, attach
Yes
No
Date
a copy of documents.
State
Q.
Q.
Obtained benefits as a result of establishing or maintaining a claim of residency in another state or
Yes
No
country? If YES, attach an explanation.
Vehicle Plate #
State
R.
Yes
No
R.
Maintained a vehicle registered in another state or country or obtained or renewed another
License #
State
state's or country's vehicle registration?
S.
Yes
No
S.
Maintained a driver’s license in another state or country or obtained or renewed another state’s or
country’s driver’s license?
08155
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal