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Get Form 2063 (rev. February 1998). U.s. Departing Alien Income Tax Statement

Termination Assessment Has Not Been Made or For a Nonresident Alien Having No Taxable Income From United States Sources 1 Name (please type or print) 2 U.S. address (number, street, and apt. no. or rural route) 3 Complete foreign address (IRS Form 2063) OMB No. 1545-0138 This certifies that Social security number or ITIN, if any (City) (State and ZIP code) has satisfied all United States of America income tax obligations with respect to income received or to be received for , , the.

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