TXL-125; Railroad Retirement Tax Notice

TXL-125
(09-11)

RAILROAD RETIREMENT TAX NOTICE
UNITED STATES OF AMERICA
RAILROAD RETIREMENT BOARD
844 N RUSH ST
CHICAGO. IL 60611-2092

DATE:

Your tax treaty exemption claim for reduced tax withholding under a treaty between your country
of residence for tax purposes and the United States will soon expire. If you do not wish to
renew your tax treaty exemption claim, you do not need to take any action.
If you wish to renew your tax treaty exemption claim, read the enclosed Form TB-125, Completion
I nstructions For Form RRB-IOO I, Nonresident Questionnaire. Use the instructions to complete the
attached Form RRB-l00l. You must provide a United States taxpayer identifying number in item
B. Do not provide a social security or social insurance number issued to you by a country other than
the United States. See Form TB-125 for action to take if you do not have a United States number.
If you wish to renew your tax treaty exemption, you must do ~.of the following,
(1)
(2)
(3)
(4)
(5)

Furnish your United States taxpayer identifying number in item B, and
Enter your claimed country of residence for tax purposes in item-----Z, and.
Check the tax treaty exemption claim box "YES" in item 3, and
Sign and date the form in item 5, and
Use the envelope provided to returrlThe completed form to the office shown on the back
of Form RRB-100l. Be sure the address shows through the window portion of the envelope.
Director of Operations

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NONRESIDENT QUESTIONNAIRE
A RRB CLAIM NUMBER

FORM APPROVED OMB NO. 3220-0145

1. Enter your claimed
country of citizenship

B. YOUR UNITED STATES TAXPAYER
IDENTIFYING NUMBER

2. Enter your claimed country
of legal residence

~

I
I

I
I

DO NOT COMPLETE

Note: If this is different than the country shown in item G. you
must submit proof of residency for the country entered in item 2.
C. PAYEE CODE

E. till CD

In
-

I

D. CNTRY lEG RESID

RNEW RESP

G. NAME AND ADDRESS

In
F.

3. Do you claim exemption Irequest reduced tax withholding) under any tax treaty
DYES
in effect between your country of legal residence and the United States? ~
NO

o

EXEMPT

Note: To receive an exemption. you MUST comply with certain requirements.
See Form TB-125 for more information about claiming an exeml!tion.
4. Enter your United States passport number only
if you have a U.S. passport that has not expired.

I

DO NOT COMPLETE

I

5. I understand that making a false or fraudulent statement to the RRB is a crime
punishable by Federal law. I certify that the information provided on this
certificate is true. complete. and correct I will notify the RRB within 30 days
of any change in this information.
---? SIGNATURE

AND DATE

This certificate MUST BE SIGNED to be valid.

(MOl (DAY) (YR)
Form RRB-1001 18-98)