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Parent Non-Filer Certification
(Parent(s) Stepmother, Stepfather, or Guardian)

Note:  Whether you filed a tax return or not, you must submit copies of all W-2 and/or 1099 forms received for the 2022 tax year.

Parent(s) who will not file a 2022 Federal Income Tax Return must complete this form.

Please complete ALL sections of the form.  Enter “0” if you did not receive any taxable and/or nontaxable income.

If you see this don't fill out this input box!

Contact Information

*Today's Date

*Email

*Last Name

*First Name

Middle Initial

*Current Mailing Address

*Apt # or P.O. Box

*City

*State

*Zip Code

*Permanent Mailing Address

Apt # or P.O. Box

*City

*State

*Zip Code

Federal Tax Information

The information below pertains to (check one):

Both Parents Mother (Guardian) Stepmother Father (Guardian) Stepfather

I (we) did not and will not file a 2022 Federal Income Tax Return, IRS Form 1040, 1040A, or 1040EZ for the following reasons (check one):

Received no taxable incomeTaxable income received was less that the amount required for filing a tax return

List amount of taxable incomes

*My (our) total income (taxable and/or nontaxable) for 2022 (January 1 - December 31) was

*Source of income

*Signature

Submit  Cancel