2015-16 Independent Student Tax Statement Worksheet Template Page 2
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2Verification of 2014 Income Information
for Individuals with Unusual Circumstances
Individuals Granted a Filing Extension by the IRS
If an individual is required to file a 2014 IRS income tax return and has been granted a filing extension by the IRS, provide
the following documents:
A copy of IRS Form 4868, “Application for Automatic Extension of Time to File U.S. Individual Income Tax Return,”
that was filed with the IRS for tax year 2014.
A copy of the IRS’s approval of an extension beyond the automatic six-month extension if the individual requested an
additional extension of the filing time for tax year 2014; and
A copy of IRS form W-2 for each source of employment income received for tax year 2014 and, if self-employed, a
signed statement certifying the amount of the individual’s Adjusted Gross Income (AGI) and the U.S. income tax paid
for tax year 2014.
Individuals Who Filed an Amended IRS Income Tax Return
If an individual filed an amended IRS income tax return for tax year 2014, provide both of the following:
A signed copy of the original 2014 IRS income tax return that was filed with the IRS or a 2014 IRS Tax Return
Transcript or the 2014 tax year; and
A signed copy of the 2014 IRS Form 1040X, “Amended U.S. Individual Income Tax Return,” that was filed with the IRS.
Individuals Who Were Victims of IRS Identity Theft
In instances when the tax filer has been the victim of identity theft, we will accept for verification:
Signed copy of the paper IRS income tax return that was filed with the IRS –and-
Either a signed and dated IRS Form 14039 “Identify Theft Affidavit” –or-
Signed and dated statement by the tax filer indicating victim of identity theft, that IRS is investigating the matter and
they submitted Form 14039 to the IRS, but did not keep a copy of it or that he or she was not required to file the form
–or-
Copy of police report if it was filed related to the IRS identity theft.
Individuals Who Filed Non-IRS Income Tax Returns
An individual who filed or will file a 2014 income tax return with Puerto Rico, another U.S. territory (e.g., Guam, American
Samoa, the U.S. Virgin Islands, the Northern Marianas Islands), or with a foreign country, must provide a signed copy of
that 2014 income tax return(s).
Return your completed form to Bronco Express on the lower level of the Bernhard Center, or mail. Be sure to
include your name and WIN on all pages. Missing information may delay the processing of financial aid.
WMU Student Financial Aid
| 1903 W. Michigan Ave., Kalamazoo, MI 49008-5337 | (269) 387-6000
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