Instructions For Adult Supplemental Schedule 2004

2004 A

DULT

UPPLEMENTAL

CHEDULE

NSTRUCTIONS

Important: Send your Adult Supplemental Schedule (if required) along with your completed Adult PFD application.

Complete an Adult Supplemental Schedule ONLY if you

Question 3— If this is the first time you are applying for a div-

are an adult who:

idend you must provide a certified copy of your birth certifi-

cate, original passport or original naturalization papers. We

•

Has never filed for a dividend before – answer

will return your original documents if you provide a self-

all questions

addressed stamped envelope with your application.

•

Did not receive a 2003 dividend – answer all

questions

Question 4A— Answer YES if you are absent from or are liv-

•

Is outside Alaska – complete Parts B and C

ing outside of Alaska when you complete this form. Example:

only

If you are a student attending school out of state, or if you are

•

Was absent for a total of 90 days or more

absent from Alaska on vacation when you file your applica-

during 2003 – complete Parts B and C only

tion, answer YES and list the date you departed Alaska and

answer 4B and 4C to clearly indicate if and when you expect

Fill in your name as it appears on your application, your date

to return to Alaska to remain indefinitely. If you answer NO to

of birth and your Social Security number (SSN). You must

Question 4A, go to Question 5.

sign this form. If you do not sign this form, you may be

Question 5A— Answer YES if you are married or NO if you are

requested to complete this form again.

not married.

Question 1— List the month, day and year you physically

Question 5B— If you are married and your spouse is not fil-

arrived in Alaska with the intent to remain indefinitely. It may

be the day you were born in Alaska. If you moved from

ing, you must attach an explanation.

Alaska to become a resident elsewhere and have since

Question 6— Answer YES only if you maintained your princi-

moved back, list the month, day and year you returned.

pal home in Alaska or stored the majority of your personal

Question 2 A-G— List the month and year for each Alaska

belongings in Alaska from December 31, 2002, through the

residency tie you have established. If you are a first-time filer,

date you file your application and Supplemental Schedule.

or if you have had a break in your Alaska residency, you must

Check the appropriate box as to whether you own, lease, rent,

attach proof or documentation. You must provide a minimum

live with parents, or store the majority of your household

of one piece of documentation dated before January 1, 2003

belongings in Alaska. List the physical address of the home

showing that you:

or storage facility you maintained in Alaska. (Example: if you

left Alaska on November 1, 2002, but did not continue to own,

•

Moved your household belongings to

lease or rent a home; or store your belongings in Alaska dur-

Alaska; or

ing your entire absence, answer No).

•

Purchased, leased or rented a place to live

CAUTION: Carefully read each question in Part C before

in Alaska; or

answering. If you are required to attach a copy or explana-

•

Obtained employment in Alaska.

tion, please do so.

The more evidence you provide with your application the

Question 7A— Answer YES if you maintained your principal

quicker the application can be processed.

Examples of

acceptable documentation are:

home outside of Alaska at any time since December 31, 2002,

whether you spent a majority of your time at that home or not.

•

Shipping receipts

If you answered YES, check the appropriate box as to

•

Mortgage or rent receipts

whether or not you own, lease, rent, or live with parents. If

•

A letter from your Alaskan employer

none of these boxes apply, check the box titled Other and

•

Documentation of any other action you

provide an explanation.

List the physical address of the

took to establish residency in Alaska

home you maintained outside Alaska.

(Rev 9/03)

Instructions For Adult Supplemental Schedule 2004 - Alaska

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