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Non Filer PDF

The form certifies that the student did not file and is not required to file a 2021 federal tax return. It requests the student to disclose any sources of income in 2021, including earnings from work, social security benefits, veteran's benefits, untaxed interest, pensions, and other untaxed income. Fields are provided to write in the sources and amounts of income, with spaces for attachments like W-2 forms as applicable. The student certifies the income information is complete and accurate by signing and dating the form.

Uploaded by

Kamal Grover
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85 views1 page

Non Filer PDF

The form certifies that the student did not file and is not required to file a 2021 federal tax return. It requests the student to disclose any sources of income in 2021, including earnings from work, social security benefits, veteran's benefits, untaxed interest, pensions, and other untaxed income. Fields are provided to write in the sources and amounts of income, with spaces for attachments like W-2 forms as applicable. The student certifies the income information is complete and accurate by signing and dating the form.

Uploaded by

Kamal Grover
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Financial Aid & Educational Financing

OCOLUMBIA UNIVERSITY
IN THE CITY OF NEW YORK
Columbia College &Columbia Engineering
Office Location: 618 Alfred Lerner Hall
Phone: 212-854-3711
Website: http://cc-seas. financlalald.columbia.edu/
Upload to |DOC or email to
2021 Student Tax Non-Filer Certification Form
[email protected]

Student Name: Wardaan Grover ID #: Cp04722265

Please Note: Students should complete this form only if NOoT FILING a2021 federal income tax return.
Instructions:
FILLABLE form: First save this form to your computer, then type your answers, re-save, print and sign. Please confirm that
your data has been included before submitting.
Icertify that Idid not, willnot and am not required to file a 2021 federal income tax return. (Please refer to IRS Guidelines
to confirm Tax Filing Requirements: https://www.irs.gov/help/ita/do-i-need-to-file-a-tax-return. US Citizens and US
Permanent Residents who are claimed as a dependent on another taxpaver's federal tax return must file their own federal
tax return if earned income exceeds $12,550.)
Indicate source(s) of student income in 2021; do not report any income received by the parent on the student's behalf.
DO NOT LEAVE ANYTHING BLANK. WRITE IN "$O.00" OR "N/A" WHERE APPROPRIATE.
(O)$0 Student Income: Iconfirm that I earned/received no income for 2021

(the student) earned/received income for 2021 (detailed below).


Contributions
Income from work (Federal Work-Study earnings): sO Attach a W-2 form.
toward Retirement:
W-2Box 12 (Code
Income from work (non-Work Study earnings): Attach a W-2 form, if available. D,E,F,G, H, or S)

Social Security Attach Form 1099.

Public Assistance Do not include food stamps or subsidized housing.

Veteran's Affairs Benefits

Untaxed Interest Income Attach a year-end statement from your bank showing the interest received in 2021.

Untaxed Pension Benefits


s0
Other untaxed income

(please explain: support from relatives, disability benefits, etc. )


TOTAL 2021 INCOME
so.00
SPECIAL CIRCUMSTANCES/EXPLANATIONS:

I(we) certify that | (we) did not and will not file a 2021 federal income tax return. The income information listed above is accurate
and complete.
SIGNATURE OF STUDENT DATE o2/17/2023

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