Form 2063 - U.s. Departing Alien Income Tax Statement Page 2
Download a blank fillable Form 2063 - U.s. Departing Alien Income Tax Statement 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 2063 - U.s. Departing Alien Income Tax Statement 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
2IMPORTANT
12a
Did you receive or do you expect to receive any income subject to U.S. income tax for the tax year shown on
line 4 on the front of this form? If “Yes,” complete 12b and 12c. If “No,” go to line 13
.
.
.
.
.
.
.
Yes
No
Please keep this certificate
with your passport
b
Was U.S. income tax withheld?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Yes
No
c
Yes
No
Did you make any estimated income tax payments?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
13a
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on
Did you receive any income subject to U.S. income tax during the prior tax year? If “Yes,” complete
this form to carry out the Internal Revenue laws of the United States. Internal
13b and 13c .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Yes
No
Revenue Code sections 6001, 6011, 6012(a), 6109, and 6851, and their regulations
require that you give us the information, including your identifying number(s).
b
U.S. address shown on the income tax return you filed for that year:
Routine uses of this information include giving it to the Department of Justice for
civil and criminal litigation and to cities, states, the District of Columbia, and U.S.
commonwealths or possessions to carry out their tax laws. We may also disclose
this information to other countries under a tax treaty, to federal and state agencies
to enforce federal nontax criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism. If you do not give us the information
asked for, or provide false or incomplete information, you may be subject to
c
(2) Taxable income
(3) Tax paid
(4) Balance due
(1) Year
penalties.
You are not required to provide the information requested on a form that
is subject to the Paperwork Reduction Act unless the form displays a valid
OMB control number. Books or records relating to a form or its instructions
14
Are you liable for filing tax returns or paying taxes to the United States for any prior year not shown above? .
Yes
No
must be retained as long as their contents may become material in the
administration of any Internal Revenue law. Generally, tax returns and
Declaration. Under penalties of perjury, I declare that I have examined the above statements, and to the best of my knowledge and belief, they are true,
return information are confidential, as required by Code section 6103.
correct, and complete.
The time needed to complete and file this form will vary depending on individual
circumstances. The estimated average time is: Recordkeeping, 6 min.; Learning
Sign
about the law or the form, 3 min.; Preparing the form, 26 min.; Copying,
assembling, and sending the form to the IRS, 13 min. If you have comments
Here
concerning the accuracy of these time estimates or suggestions for making this
Signature of departing alien
Date
form simpler, we would be happy to hear from you. You can send us comments
from Click on “More Information” and then on “Comment
on Tax Forms and Publications.” You can write to the Internal Revenue Service,
Tax Forms and Publications, SE:W:CAR:MP:TFP, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Do not send your tax return or this form to this
address.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial