Form 13614-C (Ar) - Intake/interview & Quality Review Sheet (Arabic Version)
Download a blank fillable Form 13614-C (Ar) - Intake/interview & Quality Review Sheet (Arabic Version) in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 13614-C (Ar) - Intake/interview & Quality Review Sheet (Arabic Version) with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
413614-C (AR)
ﻭﺯﺍﺭﺓ ﺍﻟﻣﺎﻟﻳﺔ ﺍﻷﻣﺭﻳﻛﻳﺔ – ﺩﺍﺋﺭﺓ ﺿﺭﻳﺑﺔ ﺍﻟﺩﺧﻝ
OMB ﺭﻗﻡ ﻣﻛﺗﺏ
ﺍﻹﺳﺗﻣﺎﺭﺓ
ﺻﻔﺣﺔ ﺇﺳﺗﻳﻌﺎﺏ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ/ﺍﻟﻣﻘﺎﺑﻠﺔ ﻭﻣﺭﺍﺟﻌﺔ ﺍﻟﺟﻭﺩﺓ
1545-1964
(2017 )ﺃﻛﺗﻭﺑﺭ
.• ﻳﺭﺟﻰ ﺇﺳﺗﻛﻣﺎﻝ ﺍﻟﺻﻔﺣﺗﻳﻥ 1-3 ﻣﻥ ﻫﺫﻩ ﺍﻹﺳﺗﻣﺎﺭﺓ
:ﺳﺗﻛﻭﻥ ﺑﺣﺎﺟﺔ ﺇﻟﻰ
.• ﺃﻧﺕ ﻣﺳﺅﻭﻝ ﻋﻥ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﻋﻠﻰ ﻛﺷﻔﻙ. ﻳﺭﺟﻰ ﺗﺯﻭﻳﺩ ﻣﻌﻠﻭﻣﺎﺕ ﻛﺎﻣﻠﺔ ﻭﺻﺣﻳﺣﺔ
.W-2، 1099، 1098، 1095 • ﻣﻌﻠﻭﻣﺎﺕ ﺿﺭﺍﺋﺏ ﻣﺛﻝ ﺍﻹﺳﺗﻣﺎﺭﺍﺕ
.IRS • ﺇﻥ ﻛﺎﻧﺕ ﻟﺩﻳﻙ ﺃﺳﺋﻠﺔ، ﻳﺭﺟﻰ ﻁﺭﺣﻬﺎ ﻋﻠﻰ ﺍﻟﻣﺗﻁﻭﻉ ﺍﻟﻣﻌﺩ ﻟﻛﺷﻑ ﺍﻟﺿﺭﺍﺋﺏ ﻭﺍﻟﻣﻌﺗﻣﺩ ﻣﻥ ﻣﺻﻠﺣﺔ
.• ﺑﻁﺎﻗﺎﺕ ﺍﻟﺿﻣﺎﻥ ﺍﻹﺟﺗﻣﺎﻋﻲ ﺃﻭ ﺃﺭﻗﺎﻡ ﺍﻟﻬﻭﻳﺔ ﺍﻟﻔﺭﺩﻳﺔ ﻟﺩﺍﻓﻌﻲ ﺍﻟﺿﺭﺍﺋﺏ ﻟﺟﻣﻳﻊ ﺍﻷﺷﺧﺎﺹ ﻋﻠﻰ ﻛﺷﻑ ﺿﺭﺍﺋﺑﻙ
.• ﺑﻁﺎﻗﺔ ﻫﻭﻳﺔ ﺗﺣﻣﻝ ﺻﻭﺭﺓ )ﻣﺛﻠﺔ ﺭﺧﺻﺔ ﻗﻳﺎﺩﺓ ﺻﺎﻟﺣﺔ( ﻟﻙ ﻭﻟﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ
.ﺍﻟﻣﺗﻁﻭﻋﻭﻥ ﺍﻟﻣﺳﺎﻋﺩﻭﻥ ﻓﻲ ﺇﻋﺩﺍﺩ ﻛﺷﻔﻙ ﻣﺩﺭﺑﻭﻥ ﻋﻠﻰ ﺗﺯﻭﻳﺩ ﺧﺩﻣﺔ ﻋﺎﻟﻳﺔ ﺍﻟﺟﻭﺩﺓ ﻭﺍﻹﻟﺗﺯﺍﻡ ﺑﺄﺳﻣﻰ ﺍﻟﻣﻌﺎﻳﻳﺭ ﺍﻷﺧﻼﻗﻳﺔ
wi.voltax@irs.gov ﻋﻥ ﺳﻠﻭﻙ ﻏﻳﺭ ﺃﺧﻼﻗﻲ، ﻳﺭﺟﻰ ﻣﺭﺍﺳﻠﺗﻧﺎ ﻋﺑﺭ ﺍﻟﺑﺭﻳﺩ ﺍﻹﻟﻛﺗﺭﻭﻧﻲ ﻋﻠﻰ ﺍﻟﻌﻧﻭﺍﻥIRS ﻹﺑﻼﻍ ﻣﺻﻠﺣﺔ
(ﺍﻟﺟﺯء ﺍﻷﻭﻝ- ﻣﻌﻠﻭﻣﺎﺗﻙ ﺍﻟﺷﺧﺻﻳﺔ )إن ﻛﻨﺖ ﺗﺮﻓﻊ ﻛﺸﻔ ﺎ ً ﻣﺸﱰﻛ ﺎ ً، ﺳ ﺠ ّ ﻞ اﺳﺎﻤءﻛﻢ ﺑﱰﺗﻴﺐ ﻣﻄﺎﺑﻖ ﻟﱰﺗﻴﺐ ﻛﺸﻒ اﻟﺴﻨﺔ اﳌﺎﺿﻴﺔ
ﺭﻗﻡ ﺍﻟﻬﺎﺗﻑ
ﺍﻹﺳﻡ ﺍﻷﺧﻳﺭ/ﺍﻟﻠﻘﺏ
ﺍﻟﺣﺭﻑ ﺍﻷﻭﻝ ﻣﻥ ﺍﻷﻭﺳﻁ
1. ﺇﺳﻣﻙ ﺍﻷﻭﻝ
ﻫﻝ ﺗﺣﻣﻝ ﺍﻟﺟﻧﺳﻳﺔ ﺍﻷﻣﺭﻳﻛﻳﺔ؟
ﻻ
ﻧﻌﻡ
ﺭﻗﻡ ﺍﻟﻬﺎﺗﻑ
ﻫﻝ ﺗﺣﻣﻝ ﺍﻟﺯﻭﺟﺔ/ﺍﻟﺯﻭﺝ ﺍﻟﺟﻧﺳﻳﺔ ﺍﻷﻣﺭﻳﻛﻳﺔ؟
ﺍﻹﺳﻡ ﺍﻷﺧﻳﺭ/ﺍﻟﻠﻘﺏ
ﺍﻟﺣﺭﻑ ﺍﻷﻭﻝ ﻣﻥ ﺍﻷﻭﺳﻁ
2. ﺍﻹﺳﻡ ﺍﻷﻭﻝ ﻟﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ
ﻻ
ﻧﻌﻡ
ﺍﻟﺭﻣﺯ ﺍﻟﺑﺭﻳﺩﻱ
ﺍﻟﻭﻻﻳﺔ
ﺍﻟﻣﺩﻳﻧﺔ
ﺭﻗﻡ ﺍﻟﺷﻘﺔ
3. ﺍﻟﻌﻧﻭﺍﻥ ﺍﻟﺑﺭﻳﺩﻱ
ﺃ. ﻁﺎﻟﺑ ﺎ ً ﺑﺩﻭﺍﻡ ﻛﺎﻣﻝ
6. ﻓﻲ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ، ﻫﻝ ﻛﻧﺕ
ﻻ
ﻧﻌﻡ
5. ﻣﻧﺻﺑﻙ ﺍﻟﻣﻬﻧﻲ
4. ﺗﺎﺭﻳﺦ ﻣﻳﻼﺩﻙ
ﺝ. ﻣﻌﺎﻗ ﺎ ً ﻗﺎﻧﻭﻧﻳﺎ
ﻻ
ﻧﻌﻡ
ﻻ
ﻧﻌﻡ
ً ﺏ. ﻣﻌﺎﻗ ﺎ ً ﺗﻣﺎﻣ ﺎ ً ﻭﺩﺍﺋﻣ ﺎ
ﺃ. ﻁﺎﻟﺑ ﺎ ً ﺑﺩﻭﺍﻡ ﻛﺎﻣﻝ
9. ﻓﻲ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ، ﻫﻝ ﻛﺎﻧﺕ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ
ﻻ
ﻧﻌﻡ
8. ﻣﻧﺻﺏ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ ﺍﻟﻣﻬﻧﻲ
7. ﺗﺎﺭﻳﺦ ﻣﻳﻼﺩ ﺍﻟﺯﻭﺟﺔ/ﺍﻟﺯﻭﺝ
ً ﺝ. ﺃﻋﻣﻰ ﻗﺎﻧﻭﻧﻳ ﺎ
ﻻ
ﻧﻌﻡ
ﻻ
ﻧﻌﻡ
ً ﺏ. ﻣﻌﺎﻗ ﺎ ً ﺗﻣﺎﻣ ﺎ ً ﻭﺩﺍﺋﻣ ﺎ
ﻏﻳﺭ ﻭﺍﺛﻕ
ﻻ
ﻧﻌﻡ
01. ﻫﻝ ﻳﺳﺗﻁﻳﻊ ﺃﻱ ﺷﺧﺹ ﺍﻹﺩﻋﺎء ﺑﺈﻋﺎﻟﺗﻙ ﺃﻭ ﺇﻋﺎﻟﺔ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ ﻋﻠﻰ ﻛﺷﻑ ﺿﺭﺍﺋﺑﻬﻡ؟
ﺏ. ﺗﺑﻧﻳﺕ ﻁﻔﻼ ً ؟
ﻻ
ﻧﻌﻡ
ﻻ
ﻧﻌﻡ
ﺃ. ﻭﻗﻌﺕ ﺿﺣﻳﺔ ﺳﺭﻗﺔ ﻫﻭﻳﺔ؟
:11. ﻫﻝ ﺃﻧﺕ ﺃﻭ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ
ﺍﻟﺟﺯء ﺍﻟﺛﺎﻧﻲ - ﻣﻌﻠﻭﻣﺎﺕ ﺍﻟﺣﺎﻟﺔ ﺍﻟﺯﻭﺟﻳﺔ ﻭﺍﻷﺳﺭﺓ ﺍﻟﻣﻌﻳﺷﻳﺔ
:1. ﺣﺗﻰ 13 ﺩﻳﺳﻣﺑﺭ/ﻛﺎﻧﻭﻥ ﺍﻷﻭﻝ 7102، ﻫﻝ ﻛﻧﺕ
()ﺑﻣﺎ ﻓﻲ ﺫﻟﻙ ﺍﻟﺷﺭﺍﻛﺎﺕ ﺍﻟﻣﻧﺯﻟﻳﺔ ﺍﻟﻣﺳﺟﻠﺔ ﺃﻭ ﺍﻹﺗﺣﺎﺩﺍﺕ ﺍﻟﻣﺩﻧﻳﺔ ﺃﻭ ﻏﻳﺭﻫﺎ ﻣﻥ ﺍﻟﻌﻼﻗﺎﺕ ﺍﻟﺭﺳﻣﻳﺔ ﺑﻣﻭﺟﺏ ﻗﺎﻧﻭﻥ ﺍﻟﻭﻻﻳﺔ
ﻏﻳﺭ ﻣﺗﺯﻭﺝ ﻣﻥ ﻗﺑﻝ
ً ﻣﺗﺯﻭﺟ ﺎ
ﻻ
ﻧﻌﻡ
ﺃ. ﺇﺫﺍ ﻧﻌﻡ، ﻫﻝ ﺗﺯﻭﺟﺕ ﻓﻲ ﺳﻧﺔ 7102؟
ﻻ
ﻧﻌﻡ
ﺏ. ﻫﻝ ﺃﻗﻣﺕ ﻣﻊ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ ﺃﺛﻧﺎء ﺃﻱ ﺟﺯء ﻣﻥ ﺍﻷﺷﻬﺭ ﺍﻟﺳﺗﺔ ﺍﻷﺧﻳﺭﺓ ﻣﻥ ﻋﺎﻡ 7102؟
ً ﻣﻁﻠﻘ ﺎ
ﺗﺎﺭﻳﺦ ﺍﻟﻘﺭﺍﺭ ﺍﻟﻧﻬﺎﺋﻲ
ﺗﺎﺭﻳﺦ ﺇﺗﻔﺎﻕ ﺍﻹﻋﺎﻟﺔ ﺧﻼﻝ ﺍﻹﻧﻔﺻﺎﻝ
ً ﻣﻧﻔﺻﻼ ً ﻗﺎﻧﻭﻧﻳ ﺎ
ﺳﻧﺔ ﻭﻓﺎﺓ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ
ﺃﺭﻣﻝ/ﺃﺭﻣﻠﺔ
:2. ﻋﺩﺩ ﺃﺩﻧﺎﻩ ﺃﺳﻣﺎء
.4 ﻭﻳﺗﻡ ﺍﻹﺩﺭﺍﺝ ﻋﻠﻰ ﺍﻟﺻﻔﺣﺔ
ﺇﺫﺍ ﻛﻧﺕ ﺑﺣﺎﺟﺔ ﺇﻟﻰ ﻓﺳﺣﺔ ﺇﺿﺎﻓﻳﺔ، ﺗﻭﺿﻊ ﺇﺷﺎﺭﺓ ﻫﻧﺎ
(• ﻛﻝ ﺷﺧﺹ ﻣﻥ ﺃﻗﺎﻡ ﻣﻌﻙ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ )ﻏﻳﺭﻙ ﺃﻭ ﻏﻳﺭ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ
ﻟﻺﺳﺗﻛﻣﺎﻝ ﻋﻠﻰ ﻳﺩ ﻣﺗﻁﻭﻉ ﻣﻌﺗﻣﺩ ﻭﻣﻌﺩ ﻟﻛﺷﻑ ﺍﻟﺿﺭﺍﺋﺏ
• ﺃﻱ ﺷﺧﺹ ﻗﻣﺕ ﺑﺈﻋﺎﻟﺗﻪ ﻟﻛﻧﻪ ﻟﻡ ﻳﻘﻳﻡ ﻣﻌﻙ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ
ﻫﻝ ﺩﻓﻊ ﺩﺍﻓﻊ
ﻫﻝ ﺯﻭّ ﺩ ﺩﺍﻓﻊ
ﻫﻝ ﻛﺎﻥ ﺩﺧﻝ
ﻫﻝ ﺯﻭّ ﺩ ﻫﺫﺍ
ﻫﻝ ﻫﺫﺍ
ً ﻣﻌﺎﻕ ﺗﻣﺎﻣ ﺎ
ﻁﺎﻟﺏ ﺑﺩﻭﺍﻡ
ﻣﻘﻳﻡ ﻓﻲ ﺍﻟﻭﻻﻳﺎﺕ
ﺣﺎﻣﻝ
ﺻﻠﺔ ﺍﻟﻘﺭﺍﺑﺔ ﺑﻙ
ﺗﺎﺭﻳﺦ
ﺃﻋﺯﺏ ﺃﻭ ﻣﺗﺯﻭﺝ
ﻋﺩﺩ ﺃﺷﻬﺭ
(ﺍﻹﺳﻡ )ﺍﻷﻭﻝ، ﺍﻟﻠﻘﺏ
/ ً ﺍﻟﺷﺧﺹ ﻁﻔﻼ
،)ﻣﺛﻼ ً ، ﺇﺑﻥ، ﺇﺑﻧﺔ
)ﺩﺍﻓﻌﻭ( ﺍﻟﺿﺭﺍﺋﺏ
)ﺩﺍﻓﻌﻭ( ﺍﻟﺿﺭﺍﺋﺏ
ﻫﺫﺍ ﺍﻟﺷﺧﺹ
ﺍﻟﺷﺧﺹ ﺃﻛﺛﺭ
ً ﻭﺩﺍﺋﻣ ﺎ
ﻛﺎﻣﻝ ﺍﻟﺳﻧﺔ
ﺍﻟﻣﺗﺣﺩﺓ ﺃﻭ ﻛﻧﺩﺍ ﺃﻭ
ﻟﻠﺟﻧﺳﻳﺔ
ﺍﻟﻣﻳﻼﺩ
ﺣﺗﻰ
ﺍﻹﻗﺎﻣﺔ ﻓﻲ
ﻻ ﺗﺳﺟﻝ ﺃﺩﻧﺎﻩ ﺇﺳﻣﻙ ﺃﻭ ﺇﺳﻡ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ
ً ﻗﺭﻳﺑ ﺎ ً ﻣﺅﻫﻼ
ﺃﻛﺛﺭ ﻣﻥ ﻧﺻﻑ
%50 ﺃﻛﺛﺭ ﻣﻥ
ﺃﻗﻝ ﻣﻥ
%50 ﻣﻥ
ﺍﻟﻣﺎﺿﻳﺔ
ﺍﻟﻣﻛﺳﻳﻙ ﺍﻟﺳﻧﺔ
ﺍﻷﻣﺭﻳﻛﻳﺔ
،ﺃﻡ، ﺃﺏ، ﻻ ﺃﺣﺩ
/)ﻳﻭﻡ/ﺷﻬﺭ
31/12/17
ﻣﻧﺯﻟﻙ ﺍﻟﺳﻧﺔ
()ﻧﻌﻡ/ﻻ
ﻛﻠﻔﺔ ﺻﻳﺎﻧﺔ ﻣﺳﻛﻥ
ﻣﻥ ﺍﻹﻋﺎﻟﺔ ﻟﻬﺫﺍ
050,4$؟
ﻣﻥ ﺇﻋﺎﻟﺗﻪ
ﻷﻱ ﺷﺧﺹ
(ﺍﻟﻣﺎﺿﻳﺔ )ﻧﻌﻡ/ﻻ
()ﻧﻌﻡ/ﻻ
(.ﺇﻟﺦ
(ﻋﺎﻡ
()ﻧﻌﻡ/ﻻ
()ﺃﻋﺯﺏ/ ﻣﺗﺯﻭﺝ
ﺍﻟﻣﺎﺿﻳﺔ
ﻟﻬﺫﺍ ﺍﻟﺷﺧﺹ؟
ﺍﻟﺷﺧﺹ؟
()ﻧﻌﻡ/ﻻ
ﺍﻟﺧﺎﺻﺔ؟
(ﺁﺧﺭ؟ )ﻧﻌﻡ/ﻻ
()ﺃ
()ﻧﻌﻡ/ﻻ
()ﻧﻌﻡ/ﻻ
()ﻧﻌﻡ/ﻻ
()ﺡ
()ﻭ
()ﻩ
()ﺝ
()ﺏ
()ﺯ
()ﺩ
()ﻁ
13614-C (AR)
58970P ﺍﻟﻛﺗﺎﻟﻭﺝ ﺭﻗﻡ
(2017-10 )ﺗﻌﺩﻳﻝ
ﺍﻹﺳﺗﻣﺎﺭﺓ
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial