Parent - Verification Instructions For Tax Extension Filers Page 2
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California State University, Chico
Parent - Preliminary Verification of Income For Tax Extension Filers
Student Last Name:
Student First Name:
RETURN TO: Student Ser vices Ctr . 250
Financial Aid and Scholarship Office
Chico State ID:
Phone:
Chico, CA 95929-0705
Phone: 530-898-6451 Fax: 530-898-6883
E-mail:
E-mail: finaid@csuchico.edu
Web site:
Address:
Facebook:
Street
City
State
Zip
Your parent(s) were granted a 2015 tax filing extension by the IRS. In order to verify 2015 income information, your parent(s) must
complete this form, and attach the required documentation from SECTION A and SECTION B. You are required to complete the
final verification process by November 4, 2016 by using the IRS Data Retrieval Tool or by submitting your parent(s) tax return
transcripts. Failure to do so will result in repayment of preliminarily disbursed aid and cancelation of future aid for 2016-17.
The following information in Section A and Section B is required to receive a preliminary financial aid
disbursement for Fall 2016.
SECTION A — Complete the information below:
FATHER/
MOTHER/
INCOME AND RESOURCES
STEPFATHER
STEPMOTHER
$
$
1. Wages (salaries, tips)
Attach a copy of your 2015 W-2 Form(s) (if applicable)
2. Interest Income
$
$
Attach copies of 1099 Form(s) (if applicable)
3. Dividend Income
$
$
4. Other taxable Income
$
$
Alimony, pensions, other real estate and investments, unemployment,
capital gains/losses, royalties, trusts.
Specify:
5. Nontaxable Income
$
$
Child support, veteran’s benefits, IRA/KEOGH plans.
Specify:
6. Business Income
$
$
Including partnerships, S Corporations, and farm income.
Attach a signed statement with the amount of business earnings or a
1099-MISC form (if applicable).
$
$
TOTAL INCOME
$
$
7. 2015 Estimated Taxes from line 56 on 1040
Do not include self employment tax.
Comments:
Complete Section B on the following page.
P-verIncTaxExt17
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