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Form As 2781.1 - Certification Of Reasons For Which The Taxpayer Is Not Required By Law To File The Individual Income Tax Return

Form AS 2781.1

Government of Puerto Rico

Rev. Aug 10 10

DEPARTMENT OF THE TREASURY

Internal Revenue Area

CERTIFICATION OF REASONS FOR WHICH THE TAXPAYER IS NOT

REQUIRED BY LAW TO FILE THE INDIVIDUAL INCOME TAX RETURN

PART I

TAXPAYER'S GENERAL INFORMATION (To be completed by the taxpayer)

(If the certification is prepared for a deceased taxpayer include the decedent's information and complete the Declaration of Part V)

Social Security Number

Taxpayer's Name

Spouse's Name

Spouse's Social Security Number

(

)

(

)

Home Telephone

Work Telephone

Home Address (Town or Urbanization, Number, Street, City, Country, Zip Code)

Postal Address (Post Office Box, City, Country, Zip Code)

PART II - REASONS FOR WHICH YOU DID NOT FILE YOUR RETURN (To be completed by the taxpayer)

I certify that for each one of the taxable years detailed below, my personal status and the reasons for which I did not file the income tax return are the following:

Reasons

Taxable Year

Personal Status

PART III - PURPOSE OF THIS CERTIFICATION (To be completed by the taxpayer)

PART IV - TAXPAYER'S SWORN STATEMENT (To be completed by the taxpayer)

I, _________________________________, resident of ___________________________________, voluntarily declare under penalties of perjury that the

information provided in this document is true, correct and complete.

__________________________________________________________

____________________________________________________

________________________________

Signature or Mark of the Taxpayer, Tutor or Representative

Name and Signature of Witness of the Mark

Date

__________________________________________________________

____________________________________________________

________________________________

Signature or Mark of the Spouse

Name and Signature of Witness of the Mark

Date

Retention Period: Ten (10) years.

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Form As 2781.1 - Certification Of Reasons For Which The Taxpayer Is Not Required By Law To File The Individual Income Tax Return

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