Tax Return Non-Filing Affidavit Form

Tax Return Non-Filing Affidavit Form
Affidavit to declare non-filing of a tax return for a specified year. Please complete all required fields and sign to certify your statement.
Full Name
First NameLast Name
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Mailing Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Tax Year for Which No Return Was Filed
If you selected 'Other' above, please specify the tax year(s)
Reason for Not Filing a Tax Return
Other (please specify below)
If 'Other', please provide details
Have you filed a tax return for any other year(s)?
If yes, list the year(s) you have filed
Signature
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