Federal Free Printable Form 2063 (Rev. September 2013) for 2017 Federal U.S. Departing Alien Income Tax Statement

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U.S. Departing Alien Income Tax Statement
Form 2063 (Rev. September 2013)

2063 U.S. Departing Alien Income Tax Statement (Rev. September 2013) For a Resident Alien Against Whom a Termination Assessment Has Not Been Made or for a Nonresident Alien Having No Taxable Income From United States Sources ▶ Information about Form 2063 is available at www.irs.gov/form2063. Form Department of the Treasury Internal Revenue Service 1 Name (please print or type) Annual Certificate of Compliance (IRS Form 2063) OMB No. 1545-0138 This certifies that Social security number or ITIN, if any has satisfied all United States of America income tax obligations with respect to income received or to be received for , , the tax year ended determined to the extent practicable, based on all information available to me on this date. 2 U.S. address (number, street, apt. no. or rural route, city, state, and ZIP code) 3 Foreign address (street address, city or town, state or province, country, and ZIP or foreign postal code) (Field Assistance Area Director) Internal Revenue Service 4 Tax year 5 While in the U.S., check if you were: 6 Of what country are you a citizen or subject? An employee 7 Passport or alien registration card number By (Name and title) Self-employed 8 Date of departure (MM/DD/YYYY) 9 Original date of your entry into the U.S. (MM/DD/YYYY) 11 Are you a resident alien of the U.S.? 10 Date on which you last arrived in the U.S. (MM/DD/YYYY) Area Director’s Stamp Yes No If “No,” enter the country of which you are a resident ▶ Cat. No. 21420Y For Privacy Act and Paperwork Reduction Act Notice, see back of form. 12a b c 13a Did you receive or do you expect to receive any income subject to U.S. income tax for the tax year shown on line 4 on the front of this form? If “Yes,” complete 12b and 12c. If “No,” go to line 13 . . . . . . . Was U.S. income tax withheld? . . . . . . Did you make any estimated income tax payments? . . . . . . . . . . . . . . . . . . . . . . . . . . Did you receive any income subject to U.S. income tax during the prior tax year? If “Yes,” complete 13b and 13c . . . . . . . . . . . . . . . . . . . . . . . . . . b U.S. address shown on the income tax return you filed for that year: c (1) Year 14 . . (2) Taxable income (3) Tax paid . . . . . . . . . IMPORTANT Yes Yes Yes Yes No No No No (4) Balance due Are you liable for filing tax returns or paying taxes to the United States for any prior year not shown above? . Yes No Declaration. Under penalties of perjury, I declare that I have examined the above statements, and to the best of my knowledge and belief, they are true, correct, and complete. ▲ Sign Here Signature of departing alien Date Please keep this certificate with your passport Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 6001, 6011, 6012(a), 6109, and 6851, and their regulations require that you give us the information, including your identifying number(s). Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths or possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. If you do not give us the information asked for, or provide false or incomplete information, you may be subject to penalties. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103. The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is: Recordkeeping, 6 min.; Learning about the law or the form, 3 min.; Preparing the form, 26 min.; Copying, assembling, and sending the form to the IRS, 13 min. If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can send us comments from www.irs.gov/formspubs/. Click on “More Information” and then on “Comment on Tax Forms and Publications.” You can write to the Internal Revenue Service, Tax Forms and Publications, SE:W:CAR:MP:TFP, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send your tax return or this form to this address.
Extracted from PDF file 2016-federal-form-2063.pdf, last modified September 2006

More about the Federal Form 2063 Other TY 2016

We last updated the U.S. Departing Alien Income Tax Statement in May 2017, so this is the latest version of Form 2063, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 2063 directly from TaxFormFinder. You can print other Federal tax forms here.

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 2063 from the Internal Revenue Service in May 2017.

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Historical Past-Year Versions of Federal Form 2063

We have a total of five past-year versions of Form 2063 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form 2063

Form 2063 (Rev. September 2013)

U.S. Departing Alien Income Tax Statement 2015 Form 2063

Form 2063 (Rev. September 2013)

U.S. Departing Alien Income Tax Statement 2013 Form 2063

Form 2063 (Rev. September 2013)

U.S. Departing Alien Income Tax Statement 2012 Form 2063

Form 2063 (Rev. June 2011)

U.S. Departing Alien Income Tax Statement 2011 Form 2063

Form 2063 (Rev. June 2011)


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