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Form 13614-NR (Rev. 10-2018)

Form 13614-NR (Rev. 10-2019) Catalog Number 39748B of the Treasury internal revenue Service Form 13614-NR (October 2019) Nonresident Alien Intake and Interview Sheet OMB Number 1545-2075 Last or Family NameFirstMiddle InitialITIN or Social Security #Visa #Passport #Date of Birth: (mm/dd/yyyy) / /Telephone #e-mail AddressWere you a citizen or resident alien the entire year? Yes No Were you ever a citizen? Yes No Local Street AddressCityStateZip CodeForeign Residence AddressAddress Line 2 Foreign CountryProvince/CountyPostal CodeCountry of CitizenshipCountry that issued PassportAre you married?

Form 13614-NR (Rev. 10-2018) . Catalog Number 39748B www.irs.gov. Department of the Treasury — Internal Revenue Service . Form . 13614-NR . Nonresident Alien Intake and Interview Sheet

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Transcription of Form 13614-NR (Rev. 10-2018)

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