Student - Verification Of Inability To Obtain Tax Transcript

15-16

California State University, Chico

Student - Verification of Inability to Obtain Tax Transcript – Identity Theft

Last Name:

First Name:

RETURN TO: Student Ser vices Ctr . 250

Financial Aid and Scholarship Office

Chico State ID:

Phone:

Chico, CA 95929-0705

E-mail:

Phone: 530-898-6451 Fax: 530-898-6883

E-mail: finaid@csuchico.edu

Address:

Web site:

Street

City

State

Zip

You have indicated that you are unable to obtain a copy of your 2014 Tax Transcript because you are a victim of tax-related identity

theft. You must complete this form and attach the following required documents.

If you are married, provide your spouse’s full name________________________________________________________________

If you are married, indicate if you and your spouse filed separate 2014 federal tax returns:

Yes

If yes, indicate if this form is for your spouse’s 2014 federal tax filing situation:

Yes

If you or your spouse are a victim of tax-related identity theft and the IRS has been made aware of your tax-related identity theft,

check both the following boxes:

I, the student or spouse, am a victim of tax-related identity theft..

The IRS has been made aware that I am a victim of tax-related identity theft.

In order to provide CSU, Chico Financial Aid and Scholarship Office with your 2014 tax filing

information, you are required to:

1) Contact the IRS at 1-800-908-4490 to report your identity theft issue.

2) Once the IRS completes your identity authentication, a 2014 TRDB tax return printout will be mailed to you. When you receive

the TRDB printout, make a copy and keep the originals for your records.

3) Attach a copy of all the pages of your 2014 TRDB tax return printout to this form and submit both forms to the Financial Aid

and Scholarship Office. Make sure you print your (student’s) name and Chico State ID number at the top of each page of your

2014 TRDB tax return printout.

Note: If you ar e mar r ied and you filed separ ate 2014 r etur ns, and your spouse has identity theft issues, they ar e r equir ed to

contact the IRS at the above telephone number to obtain their 2014 tax return printout.

Certification Statement

I hereby certify that I, or my spouse, are a victim of tax-related identity theft. The IRS has been made aware of the

tax-related identity theft. This form is accurate and complete to the best of my knowledge.

Student Signature_____________________________________________________________________ Date______________

Spouse Signature (if applicable) _________________________________________________________ Date______________

Fax to 530-898-6883. Faxed documents will show up as “received” within 72 hours on the Student Center “To Do List”.

Documents submitted in-person or by mail will show as “received” within five weeks.

S-verNoTxTrans-IT-16

Z16TST or Z16TMT

Student - Verification Of Inability To Obtain Tax Transcript - Identity Theft

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