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Ahtasham Ahmed Case - Compressed
Ahtasham Ahmed Case - Compressed
AHTSHAM AHMAD
C/O GRANTAX/IIE PO BOX 20507 DHCC
NEW YORK, NY 10017
DEAR AHTSHAM:
COPY
MARKS PANETH LLP
2018 TAX RETURN FILING INSTRUCTIONS
U.S. NONRESIDENT ALIEN INCOME TAX RETURN
PREPARED FOR:
AHTSHAM AHMAD
C/O GRANTAX/IIE PO BOX 20507 DHCC
NEW YORK, NY 10017
PREPARED BY:
AMOUNT OF TAX:
TOTAL TAX $ 11
LESS: PAYMENTS AND CREDITS $ 14
PLUS: INTEREST AND PENALTIES $ 0
OVERPAYMENT $ 3
OVERPAYMENT:
COPY
CREDITED TO YOUR ESTIMATED TAX $ 0
REFUNDED TO YOU $ 3
NOT APPLICABLE
THIS RETURN HAS BEEN PREPARED FOR ELECTRONIC FILING AND THE
PRACTITIONER PIN PROGRAM HAS BEEN ELECTED. PLEASE SIGN AND RETURN
FORM 8879 TO OUR OFFICE. WE WILL THEN TRANSMIT YOUR RETURN
ELECTRONICALLY TO THE IRS.
SPECIAL INSTRUCTIONS:
U.S. Individual Income Tax Transmittal for an IRS e-file Return
8453
OMB No. 1545-0074
Form For the year January 1 - December 31, 2018
Department of the Treasury
Internal Revenue Service
| See instructions.
| Go to www.irs.gov/Form8453 for the latest information. 2018
Your first name and initial Last name Your social security number
P
R AHTSHAM AHMAD 036 81 8644
I If a joint return, spouse's first name and initial Last name Spouse's social security number
N
Please T
print or
C
Home address (number and street). If you have a P.O. box, see instructions. Apt. no. K Important! K
type. C/O GRANTAX/IIE PO BOX 20507 DHCC You must enter
L
E City, town or post office, state, and ZIP code (If a foreign address, also complete spaces below.) your SSN(s) above.
A
R
NEW YORK, NY 10017
L Foreign country name Foreign province/state/county Foreign postal code
Y
Form 1098-C, Contributions of Motor Vehicles, Boats, and Airplanes (or equivalent contemporaneous written acknowledgement)
X
Form 2848, Power of Attorney and Declaration of Representative (or POA that states the agent is granted authority to sign the return)
Form 3468 - attach a copy of the first page of NPS Form 10-168, Historic Preservation Certification Application (Part 2 - Description of
Rehabilitation), with an indication that it was received by the Department of the Interior or the State Historic Preservation Officer, together
COPY
with proof that the building is a certified historic structure (or that such status has been requested)
Form 4136 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the provider
identifying the product as renewable diesel and, if applicable, a statement from the reseller
Form 8283, Noncash Charitable Contributions, Section A (if any statement or qualified appraisal is required), or Section B, Donated
Property, and any related attachments (including any qualified appraisal or partnership Form 8283)
Form 8332, Release/Revocation of Release of Claim to Exemption for Child by Custodial Parent (or certain pages from a divorce
decree or separation agreement, that went into effect after 1984 and before 2009) (see instructions)
Form 8858, Information Return of U.S. Persons With Respect to Foreign Disregarded Entities (FDEs) and Foreign Branches (FBs)
Form 8864 - attach the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller or a certificate from the provider
identifying the product as renewable diesel and, if applicable, a statement from the reseller
Form 8885, Health Coverage Tax Credit, and all required attachments
Form 8949, Sales and Other Dispositions of Capital Assets (or a statement with the same information), if you elect not to report your
transactions electronically on Form 8949
----
----
Spouse's name Spouse's social security number
----
----
Part I Tax Return Information - Tax Year Ending December 31, 2018 (Whole dollars only)
1 Adjusted gross income (Form 1040, line 7; Form 1040NR, line 35) ~~~~~~~~~~~~~~~~~~~~~~~ 1 100.
2 Total tax (Form 1040, line 15; Form 1040NR, line 61) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 11.
3 Federal income tax withheld from Forms W-2 and 1099 (Form 1040, line 16; Form 1040NR, line 62a) ~~~~~~ 3
4 Refund (Form 1040, line 20a; Form 1040-SS, Part I, line 13a; Form 1040NR, line 73a) ~~~~~~~~~~~~~~ 4 3.
5 Amount you owe (Form 1040, line 22; Form 1040NR, line 75) 5
Part II Taxpayer Declaration and Signature Authorization (Be sure you get and keep a copy of your return)
Under penalties of perjury, I declare that I have examined a copy of my electronic individual income tax return and accompanying schedules and statements
for the tax year ending December 31, 2018, and to the best of my knowledge and belief, they are true, correct, and complete. I further declare that the amounts
in Part I above are the amounts from my electronic income tax return. I consent to allow my intermediate service provider, transmitter, or electronic return
originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the
reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial
Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment
of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This authorization is to
remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment, I must contact the U.S.
Treasury Financial Agent at 1-888-353-4537 . Payment cancellation requests must be received no later than 2 business days prior to the payment (settlement)
date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to
answer inquiries and resolve issues related to the payment. I further acknowledge that the personal identification number (PIN) below is my signature for my
electronic income tax return and, if applicable, my Electronic Funds Withdrawal Consent.
I authorize MARKS PANETH LLP
COPY
ERO firm name
as my signature on my tax year 2018 electronically filed income tax return.
to enter or generate my PIN 1 8 6 4 4
Enter five digits, but
don't enter all zeros
I will enter my PIN as my signature on my tax year 2018 electronically filed income tax return. Check this box only if you are entering your own
PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
I will enter my PIN as my signature on my tax year 2018 electronically filed income tax return. Check this box only if you are entering your own
PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
ERO's EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN. 1 3 6 9 7 4 1 0 0 1 7
Don't enter all zeros
I certify that the above numeric entry is my PIN, which is my signature for the tax year 2018 electronically filed income tax return for the taxpayer(s)
indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Pub. 1345,
Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.
ERO Declaration
I declare that the information contained in this electronic tax return is the information furnished to me by the taxpayer. If the
taxpayer furnished me a completed tax return, I declare that the information contained in this electronic tax return is identical
to that contained in the return provided by the taxpayer. If the furnished return was signed by a paid preparer, I declare I have
entered the paid preparer's identifying information in the appropriate portion of this electronic return. If I am the paid preparer,
under the penalties of perjury I declare that I have examined this electronic return, and to the best of my knowledge and belief,
it is true, correct, and complete. This declaration is based on all information of which I have any knowledge.
ERO Signature
I am signing this Tax Return by entering my PIN below.
Taxpayer Declarations
Perjury Statement
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements,
and to the best of my knowledge and belief, they are true, correct and accurately list all amounts and sources of income I
received during the tax year. Declaration of preparer (other than the taxpayer) is based on all information of which the
COPY
preparer has any knowledge.
Consent to Disclosure
I consent to allow my Intermediate Service Provider, transmitter, or Electronic Return Originator (ERO) to send my return/form
to IRS and to receive the following information from IRS: a) an acknowledgment of receipt or reason for rejection of transmission;
b) the reason for any delay in processing or refund; and, c) the date of any refund.
I am signing this Tax Return and Electronic Funds Withdrawal Consent, if applicable, by entering my Self-Select
PIN below.
Spouse's PIN:
819986 09-25-18
U.S. Nonresident Alien Income Tax Return
1040NR
OMB No. 1545-0074
Form
2018
| Go to www.irs.gov/Form1040NR for instructions and the latest information.
Department of the Treasury For the year January 1-December 31, 2018, or other tax year
Internal Revenue Service beginning , 2018, and ending
Your first name and initial Last name Identifying number (see instr.)
AHTSHAM AHMAD 036-81-8644
X Individual
Present home address (number and street or rural route). If you have a P.O. box, see instructions. Apt. no. Check if:
Please print C/O GRANTAX/IIE PO BOX 20507 DHCC
or type Estate or Trust
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below. See instructions.
NEW YORK, NY 10017
Foreign country name Foreign province/state/county Foreign postal code
Dependents 7 Dependents: (2) Dependent's (3) Dependent's (4) u if qualifies for (see instr.):
Child tax
(1) First name Last name identifying number relationship to you credit Credit for other dependents
If more
than four
dependents,
see instructions
and check
here.
Income 8 Wages, salaries, tips, etc. Attach Form(s) W-2 ~~~~~~~~~~~~~~~~~~~~~~~~~~ 8
Effectively 9a Taxable interest ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 9a
Connected b Tax-exempt interest. Do not include on line 9a ~~~~~~~~~~ 9b
With U.S.
10a Ordinary dividends ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 10a
COPY
Trade/
Business b Qualified dividends (see instructions) ~~~~~~~~~~~~~~~ 10b
11 Taxable refunds, credits, or offsets of state and local income taxes ~~~~~~~~~~~~~~~ 11
12 Scholarship and fellowship grants. Attach Form(s) 1042-S or required statement (see instructions) 12 100.
Attach 13 Business income or (loss). Attach Schedule C or C-EZ (Form 1040) ~~~~~~~~~~~~~~~ 13
Form(s) W-2,
1042-S,
14 Capital gain or (loss). Attach Schedule D (Form 1040) if required. If not required, check here 14
SSA-1042S, 15 Other gains or (losses). Attach Form 4797 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 15
RRB-1042S, Reserved
16 16
and 8288-A
here. Also 17a IRAs, pensions, and annuities ~ 17a 17b Taxable amount ~~~~~ 17b
attach
18 Rental real estate, royalties, partnerships, trusts, etc. Attach Schedule E (Form 1040) ~~~~~~ 18
Form(s)
1099-R if tax 19 Farm income or (loss). Attach Schedule F (Form 1040) ~~~~~~~~~~~~~~~~~~~~~~ 19
was withheld. Unemployment compensation ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
20 20
21 Other income. List type and amount (see instr.) ~
21
22 Total income exempt by a treaty from page 5, Schedule OI, Item L(1)(e) ~~ 22
23 Combine the amounts in the far right col. for lines 8 through 21. This is your total effectively connected inc. | 23 100.
24 Educator expenses (see instructions) ~~~~~~~~~~~~~~~ 24
Adjusted
Gross 25 Health savings account deduction. Attach Form 8889 ~~~~~~~ 25
Income 26 Moving expenses for members of the Armed Forces. Attach Form 3903 26
27 Deductible part of self-employment tax. Attach Schedule SE (Form 1040) 27
28 Self-employed SEP, SIMPLE, and qualified plans ~~~~~~~~~ 28
29 Self-employed health insurance deduction (see instructions) ~~~~ 29
30 Penalty on early withdrawal of savings ~~~~~~~~~~~~~~ 30
31 Scholarship and fellowship grants excluded ~~~~~~~~~~~ 31
32 IRA deduction (see instructions) ~~~~~~~~~~~~~~~~~ 32
33 Student loan interest deduction (see instructions) ~~~~~~~~~
33
34 Add lines 24 through 33 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 34
35 Adjusted Gross Income. Subtract line 34 from line 23 | 35 100.
36 Amount from line 35 (adjusted gross income) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 36 100.
Tax and
37 Itemized deductions from page 3, Schedule A, line 8 ~~~~~~~~~~~~~~~~~~~~~~ 37
Credits
38 Qualified business income deduction (see instructions) ~~~~~~~~~~~~~~~~~~~~~ 38
39 Exemptions for estates and trusts only (see instructions) 39
LHA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Form 1040NR (2018)
810601 01-17-19
Form 1040NR (2018) AHTSHAM AHMAD 036-81-8644 Page 2
40 Add lines 37 through 39 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 40
Tax and 100.
41 Taxable income. Subtract line 40 from line 36. If zero or less, enter -0- ~~~~~~~~~~~~~~ 41
Credits 11.
(continued) 42 Tax (see inst.). Check if any is from Form(s): a 8814 b 4972 c 42
43 Alternative minimum tax (see instructions). Attach Form 6251 ~~~~~~~~~~~~~~~~~ 43
44 Excess advance premium tax credit repayment. Attach Form 8962 ~~~~~~~~~~~~~~~ 44
45 Add lines 42, 43, and 44 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | 45 11.
46 Foreign tax credit. Attach Form 1116 if required ~~~~~~~~~ 46
47 Credit for child and dependent care expenses. Attach Form 2441 ~ 47
48 Retirement savings contributions credit. Attach Form 8880 ~~~~ 48
49 Child tax credit and credit for other dependents (see instructions) ~ 49
50 Residential energy credit. Attach Form 5695 ~~~~~~~~~~~~ 50
51 a 3800
Other credits from Form: b 8801 c 51
52 Add lines 46 through 51. These are your total credits ~~~~~~~~~~~~~~~~~~~~~~ 52
53 Subtract line 52 from line 45. If zero or less, enter -0- | 53 11.
54 Tax on income not effectively connected with a U.S. trade or business from page 4,
Other
Schedule NEC, line 15 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 54
Taxes
55 Self-employment tax. Attach Schedule SE (Form 1040) ~~~~~~~~~~~~~~~~~~~~~ 55
56 Unreported social security and Medicare tax from Form: a 4137 b 8919 ~~~~~ 56
57 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required ~~~~ 57
58 Transportation tax (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 58
59a Household employment taxes from Schedule H (Form 1040) ~~~~~~~~~~~~~~~~~~ 59a
b Repayment of first-time homebuyer credit from Form 5405. Attach Form 5405 if required ~~~~~ 59b
60 Taxes from: a Form 8959 b Instructions; enter code(s) 60
61 Total tax. Add lines 53 through 60 | 61 11.
62 Federal income tax withheld from:
Payments
a Form(s) W-2 and 1099 ~~~~~~~~~~~~~~~~~~~~~~ 62a
COPY
b Form(s) 8805 ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 62b
c Form(s) 8288-A ~~~~~~~~~~~~~~~~~~~~~~~~~ 62c
d Form(s) 1042-S ~~~~~~~~~~~~~~~~~~~~~~~~~~ 62d 14.
63 2018 estimated tax payments and amount applied from 2017 return 63
64 Additional child tax credit. Attach Schedule 8812 ~~~~~~~~~ 64
65 Net premium tax credit. Attach Form 8962 ~~~~~~~~~~~~ 65
66 Amount paid with request for extension to file (see instructions) ~~ 66
67 Excess social security and tier 1 RRTA tax withheld ~~~~~~~~ 67
68 Credit for federal tax on fuels. Attach Form 4136 ~~~~~~~~~ 68
69 a 2439 b Res. c 8885 d
Credits from Form: 69
70 Credit for amount paid with Form 1040-C ~~~~~~~~~~~~~ 70
71 Add lines 62a through 70. These are your total payments | 71 14.
72 If line 71 is more than line 61, subtract line 61 from line 71. This is the amount you overpaid ~~~ 72 3.
Refund 3.
Direct deposit?
73a Amount of line 72 you want refunded to you. If Form 8888 is attached, check here | ~~ 73a
See b Routing number | c Type: Checking Savings
instructions.
d Account number
e If you want your refund check mailed to an address outside the United States not shown on page 1, enter it here.
74 Amount of line 72 you want applied to your 2019 estimated tax | 74
Amount 75 Amount you owe. Subtract line 71 from line 61. For details on how to pay, see instructions ~~ | 75
You Owe 76 Estimated tax penalty (see instructions) 76
Third Party Do you want to allow another person to discuss this return with the IRS? See instructions X Yes. Complete below. No
Designee
Designee's
name | WENDY LAU Phone
no. 212-984-5316
|
Personal identifi-
cation number (PIN) | 10017
Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct,
and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
=
Here Your signature
Date Your occupation in the United States
If the IRS sent you an Identity
Protection PIN, enter it here
Keep a copy of
this return
for your records. STUDENT (see inst.)
9 9 "
Paid TERRANO RICHARD P00101716
Preparer Firm's name MARKS PANETH LLP Firm's EIN 11 3518842
9
Use Only 4 MANHATTANVILLE ROAD Phone no. (914)524-9000
Firm's address PURCHASE, NY 10577
810602 01-17-19 Form 1040NR (2018)
Form 1040NR (2018) AHTSHAM AHMAD 036-81-8644 Page 3
Taxes You
Paid 1 State and local income taxes
Total
Itemized
Deductions
8 COPY
Add the amounts in the far right column for lines 1b through 7. Also, enter this amount on
Form 1040NR, line 37
7
8
Form 1040NR (2018)
810611 01-17-19
AHTSHAM AHMAD
Form 1040NR (2018) 036-81-8644 Page 4
Schedule NEC - Tax on Income Not Effectively Connected With a U.S. Trade or Business (see instructions)
Enter amount of income under the appropriate rate of tax (see instructions)
COPY
other than Canada. Note: Losses not allowed 11
12 Other (specify) |
12
13 Add lines 1a through 12 in columns (a) through (d) 13
14 Multiply line 13 by rate of tax at top of each column
14
15 Tax on income not effectively connected with a U.S. trade or business. Add columns (a) through (d) of line 14. Enter
the total here and on Form 1040NR, line 54 | 15
Capital Gains and Losses From Sales or Exchanges of Property
Enter only the capital
gains and losses from 16 (a) Kind of property and description (b) Date (c) Date (f) LOSS (g) GAIN
property sales or (if necessary, attach statement of acquired sold (e) Cost or other If (e) is more If (d) is more
exchanges that are descriptive details not shown below) (mo., day, yr.) (mo., day, yr.) (d) Sales price basis than (d), subtract (d) than (e), subtract (e)
from sources within from (e) from (d)
the United States and
not effectively
connected with a U.S.
business. Do not
include a gain or loss
on disposing of a U.S.
real property interest;
report these gains and
losses on Schedule D
(Form 1040).
Report property
sales or exchanges
that are effectively
connected with a U.S. 17 Add columns (f) and (g) of line 16 ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 17 ( )
business on Schedule
D (Form 1040), Form 18 Capital gain. Combine columns (f) and (g) of line 17. Enter the net gain here and on line 9 above (if a
4797, or both.
loss, enter -0-) | 18
Form 1040NR (2018)
810621 01-17-19
Form 1040NR (2018) AHTSHAM AHMAD 036-81-8644 Page 5
Schedule OI - Other Information (see instructions)
Answer all questions
A PAKISTAN
Of what country or countries were you a citizen or national during the tax year?
B In what country did you claim residence for tax purposes during the tax year? PAKISTAN
C Have you ever applied to be a green card holder (lawful permanent resident) of the United States? ~~~~~~~~~~~~ Yes X
No
D Were you ever:
1. A U.S. citizen? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes X
No
2. A green card holder (lawful permanent resident) of the United States? ~~~~~~~~~~~~~~~~~~~~~~~~~ Yes X
No
If you answer "Yes" to (1) or (2), see Pub. 519, chapter 4, for expatriation rules that apply to you.
E If you had a visa on the last day of the tax year, enter your visa type. If you did not have a visa, enter your U.S. immigration
status on the last day of the tax year. J-1
F Have you ever changed your visa type (nonimmigrant status) or U.S. immigration status? ~~~~~~~~~~~~~~~~ Yes X
No
If you answered "Yes," indicate the date and nature of the change. |
G List all dates you entered and left the United States during 2018. See instructions.
Note: If you are a resident of Canada or Mexico AND commute to work in the United States at frequent intervals,
check the box for Canada or Mexico and skip to item H ~~~~~~~~~~~~~~~~ Canada Mexico
Date entered United States Date departed United States Date entered United States Date departed United States
mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy
08/18/18
H Give number of days (including vacation, nonworkdays, and partial days) you were present in the United States during:
2016 0 , 2017 0 , and 2018 136 .
I Did you file a U.S. income tax return for any prior year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes X
No
If "Yes," give the latest year and form number you filed. |
COPY
J Are you filing a return for a trust? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes X
No
If "Yes," did the trust have a U.S. or foreign owner under the grantor trust rules, make a distribution or loan to a U.S.
person, or receive a contribution from a U.S. person? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes No
K Did you receive total compensation of $250,000 or more during the tax year? ~~~~~~~~~~~~~~~~~~~~~~ Yes X
No
If "Yes," did you use an alternative method to determine the source of this compensation? ~~~~~~~~~~~~~~~ Yes No
L Income Exempt from Tax - If you are claiming exemption from income tax under a U.S. income tax treaty with a
foreign country, complete (1) through (3) below. See Pub. 901 for more information on tax treaties.
1. Enter the name of the country, the applicable tax treaty article, the number of months in prior years you claimed the treaty
benefit, and the amount of exempt income in the columns below. Attach Form 8833 if required. See instructions.
(b) Tax treaty (c) Number of months (d) Amount of exempt
(a) Country
article claimed in prior tax years income in current tax year
(e) Total. Enter this amount on Form 1040NR, line 22. Do not enter it on line 8 or line 12 ~~~~~~~~~ |
2. Were you subject to tax in a foreign country on any of the income shown in 1(d) above? ~~~~~~~~~~~~~~~~~ Yes No
3. Are you claiming treaty benefits pursuant to a Competent Authority determination? ~~~~~~~~~~~~~~~~~~~ Yes No
If "Yes," attach a copy of the Competent Authority determination letter to your return.
M Check the applicable box if:
1. This is the first year you are making an election to treat income from real property located in the United States as effectively connected
with a U.S. trade or business under section 871(d). See instructions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
2. You have made an election in a previous year that has not been revoked, to treat income from real property located in the United
States as effectively connected with a U.S. trade or business under section 871(d). See instructions |
Form 1040NR (2018)
810631 01-17-19
Form 8843 Statement for Exempt Individuals and Individuals
With a Medical Condition
OMB No. 1545-0074
8
during 2018 |
2015 COPY
For trainees, enter the name, address, and telephone number of the director of the academic or other specialized program you participated in
Were you present in the United States as a teacher, trainee, or student for any part of 2 of the 6 prior
calendar years (2012 through 2017)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes
If you checked the "Yes" box on line 8, you cannot exclude days of presence as a teacher or trainee unless you meet the Exception explained
No
in the instructions.
Part III Students
9 Enter the name, address, and telephone number of the academic institution you attended during 2018 |
SOUTHERN METHODIST UNIVERSITY, 6214 BISHOP BLVD.
DALLAS, TX 75275 214-768-3149
10 Enter the name, address, and telephone number of the director of the academic or other specialized program you participated in during 2018 |
MEGHAN MURPHY, 6214 BISHOP BLVD., DALLAS, TX 75275
214-768-3149
11 Enter the type of U.S. visa (F, J, M, or Q) you held during: | 2012 2013 2014
2015 2016 2017 . If the type of visa you held during any of these years changed, attach a
statement showing the new visa type and the date it was acquired.
12 Were you present in the United States as a teacher, trainee, or student for any part of more than 5 calendar
years? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes X No
If you checked the "Yes" box on line 12, you must provide sufficient facts on an attached statement to establish that you do not intend to reside
permanently in the United States.
13 During 2018, did you apply for, or take other affirmative steps to apply for, lawful permanent resident
status in the United States or have an application pending to change your status to that of a lawful
permanent resident of the United States? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes X
No
14 If you checked the "Yes" box on line 13, explain |
813571 11-08-18 LHA For Paperwork Reduction Act Notice, see instructions. Form 8843 (2018)
COPY