Form Cr-Aff - Affidavit By Nonresident printable pdf download

Form Cr-Aff - Affidavit By Nonresident

CR-AFF (3/10)

AFFIDAVIT BY NONRESIDENT

This form is to be completed by a nonresident member included in a composite

return filing whose tax is computed under Options 1 or 2 of Regulation 560-7-8-.34.

This form is to be completed by each nonresident member and returned to the

entity.

The completed form should be retained by the entity and made available if requested

by the Department.

Name

Taxpayer’s Federal Identification Number

Street Address

Tax Year Ending

City, State and Zip Code

Telephone Number

Georgia Filing Status (e.g. Single, Married Filing Jointly, Married

Filing Separately, Head of Household)

Flow-through Entity’s Name

Entity’s Federal Identification Number

Under penalty of perjury, I swear that the above information is to the best of my

knowledge and belief, true, correct and complete; AND that for the above stated tax

period, I do not have any income from any sources within the state of Georgia other than

from the flow-through entity listed above.

__________________________________

___________________________

Taxpayer’s Signature

Date

Form Cr-Aff - Affidavit By Nonresident