Non-U.s. Citizen Employee Tax Data Form
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1Maricopa Community Colleges
NON-U.S. CITIZEN EMPLOYEE TAX DATA FORM
Not for use by Permanent Residents OR Employment Authorization Card holders without terms listed
I. PERSONAL INFORMATION
Last Name
First Name
MI
U.S. Social Security Number
Address:
City
State
Zip Code
Phone
Date of Birth
II. DETERMINATION OF RESIDENCE STATUS FOR FEDERAL TAX WITHHOLDING
To determine whether you are considered a Resident Alien or Nonresident Alien for tax purposes, refer to chapter one of
the U.S. Internal Revenue Service's Publication 519 "U.S. Tax Guide for Aliens," which can be found at
CHECK APPROPRIATE FEDERAL TAX WITHHOLDING STATUS. (YOU MUST CHECK ONE OF THESE LINES)
_________ Resident Alien or Employment Authorization Card
________
Nonresident Alien (see below)
___F-1 Student ___J-1 Student ___J-1 Exchange Visitor ___J-2 Exchange Visitor ___Refugee ___TN: Nafta Treaty ___EAD Card-(T&C)*
*Terms and Conditions
III . IMMIGRATION 7 ALIEN TAX INFORMATION FOR TREATY
A.
Are you claiming tax treaty exemption?
YES ________
NO___________
Important: If you wish to claim exemption from U.S. Federal income taxes because your country of permanent residence
has a tax treaty with the United States, you MUST attach IRS form 8233 (Exemption from Withholding for Compensation
on Independent Personal Services of a Non-Resident Alien Individual). Copies are available from either payroll or the IRS,
and must be submitted each tax year.
B. Country of Citizenship
D. INS Classification held during first U.S. Entry
Date of Entry:_________________
C. Country of Residence (for tax purposes)
E. Expiration date of your current INS classification.
IIII. EMPLOYEE CERTIFICATION
I certify that the information entered above is correct. If a reduced rate of tax or exemption from tax applies, I further
certify that I have complied with all requirements to qualify for the reduced rate of tax or exemption from tax.
Signature: ______________________________________________________ Date: __________________________
Please check to be sure all necessary sections/boxes are completed accurately.
For College HR use only:
Employment Verification (form I-9)
Date completed:______________
E-Verify Completed
Signature: ______________________________________________________ Date: __________________________
College HR Representative
rev. 1/4/2010
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