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pdf)13614-C (AR
ﻭﺯﺍﺭﺓ ﺍﻟﻣﺎﻟﻳﺔ ﺍﻷﻣﺭﻳﻛﻳﺔ – ﺩﺍﺋﺭﺓ ﺿﺭﻳﺑﺔ ﺍﻟﺩﺧﻝ
Form
ﺭﻗﻡ ﻣﻛﺗﺏ OMB
1545-1964
ﺻﻔﺣﺔ ﺇﺳﺗﻳﻌﺎﺏ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ/ﺍﻟﻣﻘﺎﺑﻠﺔ ﻭﻣﺭﺍﺟﻌﺔ ﺍﻟﺟﻭﺩﺓ
)ﺃﻛﺗﻭﺑﺭ (2019
ﺳﺗﻛﻭﻥ ﺑﺣﺎﺟﺔ ﺇﻟﻰ:
• ﻣﻌﻠﻭﻣﺎﺕ ﺿﺭﺍﺋﺏ ﻣﺛﻝ ﺍﻹﺳﺗﻣﺎﺭﺍﺕ .1095 ،1098 ،1099 ،W-2
• ﺑﻁﺎﻗﺎﺕ ﺍﻟﺿﻣﺎﻥ ﺍﻹﺟﺗﻣﺎﻋﻲ ﺃﻭ ﺃﺭﻗﺎﻡ ﺍﻟﻬﻭﻳﺔ ﺍﻟﻔﺭﺩﻳﺔ ﻟﺩﺍﻓﻌﻲ ﺍﻟﺿﺭﺍﺋﺏ ﻟﺟﻣﻳﻊ ﺍﻷﺷﺧﺎﺹ ﻋﻠﻰ ﻛﺷﻑ ﺿﺭﺍﺋﺑﻙ.
• ﺑﻁﺎﻗﺔ ﻫﻭﻳﺔ ﺗﺣﻣﻝ ﺻﻭﺭﺓ )ﻣﺛﻠﺔ ﺭﺧﺻﺔ ﻗﻳﺎﺩﺓ ﺻﺎﻟﺣﺔ( ﻟﻙ ﻭﻟﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ.
• ﻳﺭﺟﻰ ﺇﺳﺗﻛﻣﺎﻝ ﺍﻟﺻﻔﺣﺎﺕ 4-1ﻣﻥ ﻫﺫﻩ ﺍﻹﺳﺗﻣﺎﺭﺓ.
• ﺃﻧﺕ ﻣﺳﺅﻭﻝ ﻋﻥ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﻋﻠﻰ ﻛﺷﻔﻙ .ﻳﺭﺟﻰ ﺗﺯﻭﻳﺩ ﻣﻌﻠﻭﻣﺎﺕ ﻛﺎﻣﻠﺔ ﻭﺻﺣﻳﺣﺔ.
• ﺇﻥ ﻛﺎﻧﺕ ﻟﺩﻳﻙ ﺃﺳﺋﻠﺔ ،ﻳﺭﺟﻰ ﻁﺭﺣﻬﺎ ﻋﻠﻰ ﺍﻟﻣﺗﻁﻭﻉ ﺍﻟﻣﻌﺩ ﻟﻛﺷﻑ ﺍﻟﺿﺭﺍﺋﺏ ﻭﺍﻟﻣﻌﺗﻣﺩ ﻣﻥ ﻣﺻﻠﺣﺔ .IRS
ﺍﻟﻣﺗﻁﻭﻋﻭﻥ ﻣﺩﺭﺑﻭﻥ ﻋﻠﻰ ﺗﺯﻭﻳﺩ ﺧﺩﻣﺔ ﻋﺎﻟﻳﺔ ﺍﻟﺟﻭﺩﺓ ﻭﺍﻹﻟﺗﺯﺍﻡ ﺑﺄﺳﻣﻰ ﺍﻟﻣﻌﺎﻳﻳﺭ ﺍﻷﺧﻼﻗﻳﺔ.
ﻹﺑﻼﻍ ﻣﺻﻠﺣﺔ IRSﻋﻥ ﺳﻠﻭﻙ ﻏﻳﺭ ﺃﺧﻼﻗﻲ ،ﻳﺭﺟﻰ ﻣﺭﺍﺳﻠﺗﻧﺎ ﻋﺑﺭ ﺍﻟﺑﺭﻳﺩ ﺍﻹﻟﻛﺗﺭﻭﻧﻲ ﻋﻠﻰ ﺍﻟﻌﻧﻭﺍﻥ [email protected]
ﺳﺠﻞ اﺳﺎﻤءﻛﻢ ﺑﱰﺗﻴﺐ ﻣﻄﺎﺑﻖ ﻟﱰﺗﻴﺐ ﻛﺸﻒ اﻟﺴﻨﺔ اﳌﺎﺿﻴﺔ(
ﺍﻟﺟﺯء ﺍﻷﻭﻝ -ﻣﻌﻠﻭﻣﺎﺗﻙ ﺍﻟﺷﺧﺻﻳﺔ )إن ﻛﻨﺖ ﺗﺮﻓﻊ ﻛﺸﻒﺍ ً ﻣﺸﱰكﺍًّ ،
.1ﺇﺳﻣﻙ ﺍﻷﻭﻝ
ﺍﻟﺣﺭﻑ ﺍﻷﻭﻝ ﻣﻥ ﺍﻷﻭﺳﻁ
ﺍﻹﺳﻡ ﺍﻷﺧﻳﺭ/ﺍﻟﻠﻘﺏ
ﺭﻗﻡ ﺍﻟﻬﺎﺗﻑ ﻧﻬﺎﺭﺍ ً
ﻫﻝ ﺗﺣﻣﻝ ﺍﻟﺟﻧﺳﻳﺔ ﺍﻷﻣﺭﻳﻛﻳﺔ؟
ﻻ
ﻧﻌﻡ
.2ﺍﻹﺳﻡ ﺍﻷﻭﻝ ﻟﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ
ﺍﻟﺣﺭﻑ ﺍﻷﻭﻝ ﻣﻥ ﺍﻷﻭﺳﻁ
ﺍﻹﺳﻡ ﺍﻷﺧﻳﺭ/ﺍﻟﻠﻘﺏ
ﺭﻗﻡ ﺍﻟﻬﺎﺗﻑ ﻧﻬﺎﺭﺍ ً
ﻫﻝ ﺗﺣﻣﻝ ﺍﻟﺯﻭﺟﺔ/ﺍﻟﺯﻭﺝ ﺍﻟﺟﻧﺳﻳﺔ ﺍﻷﻣﺭﻳﻛﻳﺔ؟
ﻻ
ﻧﻌﻡ
ﺍﻟﺭﻣﺯ ﺍﻟﺑﺭﻳﺩﻱ
ﺍﻟﻭﻻﻳﺔ
ﺭﻗﻡ ﺍﻟﺷﻘﺔ
.3ﺍﻟﻌﻧﻭﺍﻥ ﺍﻟﺑﺭﻳﺩﻱ
.4ﺗﺎﺭﻳﺦ ﻣﻳﻼﺩﻙ
.5ﻣﻧﺻﺑﻙ ﺍﻟﻣﻬﻧﻲ
.7ﺗﺎﺭﻳﺦ ﻣﻳﻼﺩ ﺍﻟﺯﻭﺟﺔ/ﺍﻟﺯﻭﺝ
.8ﻣﻧﺻﺏ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ ﺍﻟﻣﻬﻧﻲ
ﺍﻟﻣﺩﻳﻧﺔ
ﻏﻳﺭ ﻭﺍﺛﻖ
ﻧﻌﻡ
.6ﻓﻲ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ ،ﻫﻝ ﻛﻧﺕ
ﺏ .ﻣﻌﺎﻗﺎ ً ﺗﻣﺎﻣﺎ ً ﻭﺩﺍﺋﻣﺎ ً
ﻻ
ﻧﻌﻡ
.9ﻓﻲ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ ،ﻫﻝ ﻛﺎﻧﺕ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ
ﺏ .ﻣﻌﺎﻗﺎ ً ﺗﻣﺎﻣﺎ ً ﻭﺩﺍﺋﻣﺎ ً
ﻻ
ﻧﻌﻡ
ﺃ .ﻁﺎﻟﺑﺎ ً ﺑﺩﻭﺍﻡ ﻛﺎﻣﻝ
ﺝ .ﻣﻌﺎﻗﺎ ً ﻗﺎﻧﻭﻧﻳﺎ
ﺃ .ﻁﺎﻟﺑﺎ ً ﺑﺩﻭﺍﻡ ﻛﺎﻣﻝ
ﺝ .ﺃﻋﻣﻰ ﻗﺎﻧﻭﻧﻳﺎ ً
ﻻ
ﻧﻌﻡ
.10ﻫﻝ ﻳﺳﺗﻁﻳﻊ ﺃﻱ ﺷﺧﺹ ﺍﻹﺩﻋﺎء ﺑﺈﻋﺎﻟﺗﻙ ﺃﻭ ﺇﻋﺎﻟﺔ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ ﻋﻠﻰ ﻛﺷﻑ ﺿﺭﺍﺋﺑﻬﻡ؟
ﻻ
.11ﻫﻝ ﻭﻗﻌﺕ ﺃﻧﺕ ﺃﻭ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ ﺃﻭ ﻣﻥ ﺗﻌﻠﻳﻬﻡ ﺿﺣﻳﺔ ﺳﺭﻗﺔ ﻫﻭﻳﺔ ﺃﻭ ﺻﺩﺭ ﻟﻛﻡ ﺭﻗﻡ ﻫﻭﻳﺔ ﺷﺧﺻﻳﺔ ﻟﺣﻣﺎﻳﺔ ﻫﻭﻳﺗﻛﻡ؟
ﺍﻟﺟﺯء ﺍﻟﺛﺎﻧﻲ -ﻣﻌﻠﻭﻣﺎﺕ ﺍﻟﺣﺎﻟﺔ ﺍﻟﺯﻭﺟﻳﺔ ﻭﺍﻷﺳﺭﺓ ﺍﻟﻣﻌﻳﺷﻳﺔ
)ﺑﻣﺎ ﻓﻲ ﺫﻟﻙ ﺍﻟﺷﺭﺍﻛﺎﺕ ﺍﻟﻣﻧﺯﻟﻳﺔ ﺍﻟﻣﺳﺟﻠﺔ ﺃﻭ ﺍﻹﺗﺣﺎﺩﺍﺕ ﺍﻟﻣﺩﻧﻳﺔ ﺃﻭ ﻏﻳﺭﻫﺎ ﻣﻥ ﺍﻟﻌﻼﻗﺎﺕ ﺍﻟﺭﺳﻣﻳﺔ ﺑﻣﻭﺟﺏ ﻗﺎﻧﻭﻥ ﺍﻟﻭﻻﻳﺔ(
ﻏﻳﺭ ﻣﺗﺯﻭﺝ ﻣﻥ ﻗﺑﻝ
.1ﺣﺗﻰ 31ﺩﻳﺳﻣﺑﺭ/ﻛﺎﻧﻭﻥ ﺍﻷﻭﻝ ،2019ﻣﺎ ﻛﺎﻥ ﻭﺿﻌﻙ
ﺍﻟﺯﻭﺟﻲ؟
ً
ﻣﺗﺯﻭﺟﺎ
ﺃ .ﺇﺫﺍ ﻧﻌﻡ ،ﻫﻝ ﺗﺯﻭﺟﺕ ﻓﻲ ﺳﻧﺔ 2019؟
ﺏ .ﻫﻝ ﺃﻗﻣﺕ ﻣﻊ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ ﺃﺛﻧﺎء ﺃﻱ ﺟﺯء ﻣﻥ ﺍﻷﺷﻬﺭ ﺍﻟﺳﺗﺔ ﺍﻷﺧﻳﺭﺓ ﻣﻥ ﻋﺎﻡ 2019؟
ﻣﻁﻠﻘﺎ ً
ﺗﺎﺭﻳﺦ ﺍﻟﻘﺭﺍﺭ ﺍﻟﻧﻬﺎﺋﻲ
ﺗﺎﺭﻳﺦ ﺇﺗﻔﺎﻕ ﺍﻹﻋﺎﻟﺔ ﺧﻼﻝ ﺍﻹﻧﻔﺻﺎﻝ
ﻣﻧﻔﺻﻼ ﻗﺎﻧﻭﻧﻳﺎ ً
ً
ﺳﻧﺔ ﻭﻓﺎﺓ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ
ﺃﺭﻣﻝ/ﺃﺭﻣﻠﺔ
.2ﻋﺩﺩ ﺃﺩﻧﺎﻩ ﺃﺳﻣﺎء:
• ﻛﻝ ﺷﺧﺹ ﺃﻗﺎﻡ ﻣﻌﻙ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ )ﻏﻳﺭﻙ ﺃﻭ ﻏﻳﺭ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ(
• ﺃﻱ ﺷﺧﺹ ﻗﻣﺕ ﺑﺈﻋﺎﻟﺗﻪ ﻟﻛﻧﻪ ﻟﻡ ﻳﻘﻳﻡ ﻣﻌﻙ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ
ﺍﻹﺳﻡ )ﺍﻷﻭﻝ ،ﺍﻟﻠﻘﺏ(
ﻻ ﺗﺳﺟﻝ ﺃﺩﻧﺎﻩ ﺇﺳﻣﻙ ﺃﻭ ﺇﺳﻡ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ
)ﺃ(
ﺍﻟﻛﺗﺎﻟﻭﺝ ﺭﻗﻡ 58970P
ﺻﻠﺔ ﺍﻟﻘﺭﺍﺑﺔ ﺑﻙ
ﺗﺎﺭﻳﺦ
ً
)ﻣﺛﻼ ،ﺇﺑﻥ ،ﺇﺑﻧﺔ،
ﺍﻟﻣﻳﻼﺩ
)ﻳﻭﻡ/ﺷﻬﺭ /ﺃﻡ ،ﺃﺏ ،ﻻ ﺃﺣﺩ،
ﺇﻟﺦ(.
ﻋﺎﻡ(
)ﺏ(
)ﺝ(
ﺇﺫﺍ ﻛﻧﺕ ﺑﺣﺎﺟﺔ ﺇﻟﻰ ﻓﺳﺣﺔ ﺇﺿﺎﻓﻳﺔ ،ﺗﻭﺿﻊ ﺇﺷﺎﺭﺓ ﻫﻧﺎ
ﻧﻌﻡ
ﻧﻌﻡ
ﻧﻌﻡ
ﻧﻌﻡ
ﻧﻌﻡ
ﻧﻌﻡ
ﻻ
ﻻ
ﻻ
ﻻ
ﻻ
ﻻ
ﻭﻳﺗﻡ ﺍﻹﺩﺭﺍﺝ ﻋﻠﻰ ﺍﻟﺻﻔﺣﺔ .3
ﻟﻺﺳﺗﻛﻣﺎﻝ ﻋﻠﻰ ﻳﺩ ﻣﺗﻁﻭﻉ ﻣﻌﺗﻣﺩ ﻭﻣﻌﺩ ﻟﻛﺷﻑ ﺍﻟﺿﺭﺍﺋﺏ
ﻋﺩﺩ ﺃﺷﻬﺭ
ﺍﻹﻗﺎﻣﺔ ﻓﻲ
ﻣﻧﺯﻟﻙ ﺍﻟﺳﻧﺔ
ﺍﻟﻣﺎﺿﻳﺔ
)ﺩ(
ﺣﺎﻣﻝ
ﻟﻠﺟﻧﺳﻳﺔ
ﺍﻷﻣﺭﻳﻛﻳﺔ
)ﻧﻌﻡ/ﻻ(
)ﻩ(
ﺯﻭﺩ ﻫﺫﺍ ﻫﻝ ﻛﺎﻥ ﺩﺧﻝ
ﻣﻘﻳﻡ ﻓﻲ ﺍﻟﻭﻻﻳﺎﺕ ﺃﻋﺯﺏ ﺃﻭ ﻣﺗﺯﻭﺝ ﻁﺎﻟﺏ ﺑﺩﻭﺍﻡ ﻣﻌﺎﻕ ﺗﻣﺎﻣﺎ ً ﻫﻝ ﻫﺫﺍ
ﻫﻝ ّ
ﺍﻟﺷﺧﺹ ً
ﻛﺎﻣﻝ ﺍﻟﺳﻧﺔ ﻭﺩﺍﺋﻣﺎ ً
ﻁﻔﻼ /ﺍﻟﺷﺧﺹ ﺃﻛﺛﺭ ﻫﺫﺍ ﺍﻟﺷﺧﺹ
ﺍﻟﻣﺗﺣﺩﺓ ﺃﻭ ﻛﻧﺩﺍ ﺃﻭ ﺣﺗﻰ
ﻗﺭﻳﺑﺎ ً
ً
ﺃﻗﻝ ﻣﻥ
ﻣﻥ %50
ﻣﺅﻫﻼ
ﺍﻟﻣﻛﺳﻳﻙ ﺍﻟﺳﻧﺔ
ﺍﻟﻣﺎﺿﻳﺔ
19/12/31
)ﻧﻌﻡ/ﻻ(
$4,200؟
ﻣﻥ ﺇﻋﺎﻟﺗﻪ
ﻷﻱ ﺷﺧﺹ
ﺍﻟﻣﺎﺿﻳﺔ )ﻧﻌﻡ/ﻻ( )ﺃﻋﺯﺏ /ﻣﺗﺯﻭﺝ( )ﻧﻌﻡ/ﻻ(
)ﻧﻌﻡ/ﻻ(
ﺁﺧﺭ؟ )ﻧﻌﻡ/ﻻ( ﺍﻟﺧﺎﺻﺔ؟
)ﻧﻌﻡ/ﻻ(
)ﻭ(
)ﺡ(
)ﺯ(
)ﻁ(
www.irs.gov
ﻫﻝ ﺩﻓﻊ ﺩﺍﻓﻊ
ﺯﻭﺩ ﺩﺍﻓﻊ
ﻫﻝ ّ
)ﺩﺍﻓﻌﻭ( ﺍﻟﺿﺭﺍﺋﺏ )ﺩﺍﻓﻌﻭ( ﺍﻟﺿﺭﺍﺋﺏ
ﺃﻛﺛﺭ ﻣﻥ %50ﺃﻛﺛﺭ ﻣﻥ ﻧﺻﻑ
ﻣﻥ ﺍﻹﻋﺎﻟﺔ ﻟﻬﺫﺍ ﻛﻠﻔﺔ ﺻﻳﺎﻧﺔ ﻣﺳﻛﻥ
ﻟﻬﺫﺍ ﺍﻟﺷﺧﺹ؟
ﺍﻟﺷﺧﺹ؟
)ﻧﻌﻡ/ﻻ(
)ﻧﻌﻡ/ﻻ(
)(AR) (Rev. 10-2019
Form 13614-C
ﺍﻟﺻﻔﺣﺔ 2
ﺍﺧﺗﺭ ﺍﻟﻣﺭﺑﻊ ﺍﻟﻣﻼﺋﻡ ﻟﻛﻝ ﺳﺅﺍﻝ ﻓﻲ ﻛﻝ ﻓﻘﺭﺓ
ﻧﻌﻡ
ﻻ
ﻧﻌﻡ
ﻻ
ﻧﻌﻡ
ﻻ
ﻏﻳﺭ ﻭﺍﺛﻖ ﺍﻟﺟﺯء ﺍﻟﺛﺎﻟﺙ -ﺍﻟﺩﺧﻝ-ﻓﻲ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ ،ﻫﻝ ﺗﻠﻘﻳﺕ ﺃﻧﺕ )أو زوﺟﺘﻚ/زوﺟﻚ(
(B) .1ﺃﺟﻭﺭﺍ ً ﺃﻭ ﺭﺍﺗﺑﺎً؟ )ﺍﻹﺳﺗﻣﺎﺭﺓ (W-2ﺇﺫﺍ ﻧﻌﻡ ،ﻛﻡ ﻭﻅﻳﻔﺔ ﻛﺎﻧﺕ ﻟﺩﻳﻙ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ؟
ً (A) .2
ﺩﺧﻼ ﻣﻥ ﺍﻟﺑﻘﺷﻳﺵ؟
(B) .3ﻣﻧﺣﺎ ً ﺩﺭﺍﺳﻳﺔ؟ )ﺍﻹﺳﺗﻣﺎﺭﺍﺕ W-2ﻭ(1098T
(B) .4ﻓﻭﺍﺋﺩ/ﺃﻧﺻﺑﺔ ﺃﺭﺑﺎﺡ ﻣﻥ :ﺣﺳﺎﺑﺎﺕ ﺷﻳﻛﺎﺕ/ﺗﻭﻓﻳﺭ ،ﺳﻧﺩﺍﺕ ،ﺇﻋﺗﻣﺎﺩﺍﺕ ﻣﺳﺗﻧﺩﻳﺔ ،ﻋﻣﻭﻻﺕ؟ )ﺍﻹﺳﺗﻣﺎﺭﺓ 1099INTﻭﺍﻹﺳﺗﻣﺎﺭﺓ (1099DIV
(B) .5ﺇﺳﺗﺭﺟﺎﻉ ﺿﺭﺍﺋﺏ ﺍﻟﺩﺧﻝ ﺍﻟﻣﺣﻠﻳﺔ/ﻟﻠﻭﻻﻳﺔ؟ )ﺍﻹﺳﺗﻣﺎﺭﺓ (1099G
(B) .6ﺩﺧﻝ ﻧﻔﻘﺔ ﺍﻟﺯﻭﺟﺔ ﺍﻟﻣﻁﻠﻘﺔ/ﺍﻟﺯﻭﺝ ﺍﻟﻣﻁﻠﻖ ﺃﻭ ﻣﺩﻓﻭﻋﺎﺕ ﺇﻋﺎﻟﺔ ﺍﻟﺯﻭﺟﺔ ﺍﻟﻣﻧﻔﺻﻠﺔ/ﺍﻟﺯﻭﺝ ﺍﻟﻣﻧﻔﺻﻝ؟
(A) .7ﺩﺧﻝ ﺍﻟﻌﻣﻝ ﺍﻟﺣﺭ )ﺍﻻﺳﺗﻣﺎﺭﺓ ،1099-MISCﻣﺑﺎﻟﻎ ﻧﻘﺩﻳﺔ ،ﻋﻣﻠﺔ ﺍﻓﺗﺭﺍﺿﻳﺔ ،ﺃﻭ ﻣﻣﺗﻠﻛﺎﺕ ﺃﻭ ﺧﺩﻣﺎﺕ ﺃﺧﺭﻯ(؟
(A) .8ﻣﺩﻓﻭﻋﺎﺕ ﻧﻘﺩﻳﺔ/ﺷﻳﻛﺎﺕ/ﻋﻣﻠﺔ ﺍﻓﺗﺭﺍﺿﻳﺔ ﺃﻭ ﻣﻣﺗﻠﻛﺎﺕ ﺃﻭ ﺧﺩﻣﺎﺕ ﺃﺧﺭﻯ ﻣﻘﺎﺑﻝ ﺃﻱ ﻋﻣﻝ ﻣﺅﺩﻯ ﻭﻏﻳﺭ ﻣﺑﻠﻎ ﻋﻧﻪ ﻋﻠﻰ ﺍﻻﺳﺗﻣﺎﺭﺓ W-2ﺃﻭ ﺍﻻﺳﺗﻣﺎﺭﺓ 1099؟
(A) .9ﺍﻟﺩﺧﻝ )ﺃﻭ ﺍﻟﺧﺳﺎﺭﺓ( ﻣﻥ ﺑﻳﻊ ﺍﻷﺳﻬﻡ ﺃﻭ ﺍﻟﺳﻧﺩﺍﺕ ﺃﻭ ﺍﻟﻌﻣﻠﺔ ﺍﻻﻓﺗﺭﺍﺿﻳﺔ ﺃﻭ ﺍﻟﻌﻘﺎﺭﺍﺕ؟ )ﺍﻻﺳﺗﻣﺎﺭﺍﺕ (1099B ،1099S
(B) .10ﺩﺧﻝ ﺍﻹﻋﺎﻗﺔ )ﻣﺛﻝ ﺍﻟﻣﺩﻓﻭﻋﺎﺕ ﻣﻥ ﺍﻟﺗﺄﻣﻳﻥ ﺃﻭ ﺗﻌﻭﻳﺽ ﺍﻟﻌﻣﺎﻝ(؟ )ﺍﻹﺳﺗﻣﺎﺭﺍﺕ (1099R ،W-2
(A) .11ﺩﺧﻝ ﺗﻘﺎﻋﺩ ﺃﻭ ﻣﺩﻓﻭﻋﺎﺕ ﻣﻥ ﻣﻥ ﻣﻌﺎﺷﺎﺕ ﺍﻟﺗﻘﺎﻋﺩ ﻭ/ﺃﻭ ﺍﻟﻌﻼﻭﺍﺕ ﺍﻟﺳﻧﻭﻳﺔ ﻭ/ﺃﻭ ﺣﺳﺎﺏ IRA؟ )ﺍﻹﺳﺗﻣﺎﺭﺓ (1099R
(B) .12ﺗﻌﻭﻳﺽ ﺍﻟﺑﻁﺎﻟﺔ )ﺍﻹﺳﺗﻣﺎﺭﺓ (G-1099
(B) .13ﻣﺧﺻﺻﺎﺕ ﺍﻟﺿﻣﺎﻥ ﺍﻹﺟﺗﻣﺎﻋﻲ ﺃﻭ ﺗﻘﺎﻋﺩ ﻋﻣﺎﻝ ﺍﻟﺳﻛﻙ ﺍﻟﺣﺩﻳﺩﻳﺔ؟ )ﺍﻹﺳﺗﻣﺎﺭﺍﺕ (RRB1099 ،SSA1099
(M) .14ﺍﻟﺩﺧﻝ )ﺃﻭ ﺍﻟﺧﺳﺎﺭﺓ( ﻣﻥ ﻣﻠﻛﻳﺔ ﻣﺅﺟﺭﺓ؟
(B) .15ﺩﺧﻝ ﺁﺧﺭ؟ )ﺍﻟﻘﻣﺎﺭ ،ﺍﻟﻳﺎﻧﺻﻳﺏ ،ﺍﻟﺟﻭﺍﺋﺯ ،ﺍﻟﻣﻧﺢ ،ﻭﺍﺟﺏ ﻫﻳﺋﺔ ﺍﻟﻣﺣﻠﻔﻳﻥ ،ﺍﻟﻌﻣﻠﺔ ﺍﻻﻓﺗﺭﺍﺿﻳﺔ ،Sch K-1 ،ﺃﺗﺎﻭﺍﺕ ،ﺩﺧﻝ ﺃﺟﻧﺑﻲ ،ﻣﻣﺗﻠﻛﺎﺕ ﺃﻭ ﺧﺩﻣﺎﺕ ﺃﺧﺭﻯ ،ﺇﻟﺦ( ﻳُﺭﺟﻰ ﺍﻟﺗﺣﺩﻳﺩ
ﻏﻳﺭ ﻭﺍﺛﻖ ﺍﻟﺟﺯء ﺍﻟﺭﺍﺑﻊ-ﺍﻟﻧﻔﻘﺎﺕ -ﻓﻲ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ ،ﻫﻝ ﺩﻓﻌﺕ ﺃﻧﺕ )أو زوﺟﺘﻚ/زوﺟﻚ(
ﻧﻌﻡ
(B) .1ﻧﻔﻘﺔ ﺍﻟﺯﻭﺟﺔ ﺍﻟﻣﻁﻠﻘﺔ/ﺍﻟﺯﻭﺝ ﺍﻟﻣﻁﻠﻖ ﺃﻭ ﻣﺩﻓﻭﻋﺎﺕ ﺇﻋﺎﻟﺔ ﺍﻟﺯﻭﺟﺔ ﺍﻟﻣﻧﻔﺻﻠﺔ/ﺍﻟﺯﻭﺝ ﺍﻟﻣﻧﻔﺻﻝ؟ ﺇﻥ ﻧﻌﻡ ،ﻫﻝ ﻟﺩﻳﻙ ﺭﻗﻡ ﺍﻟﺿﻣﺎﻥ ﺍﻹﺟﺗﻣﺎﻋﻲ ﻟﻠﻣﺳﺗﻠﻡ؟
ﻏﻳﺭ ﺫﻟﻙ
(B) Roth IRA
(B) 401K
(A) IRA
.2ﻣﺳﺎﻫﻣﺎﺕ ﻓﻲ ﺣﺳﺎﺏ ﺗﻘﺎﻋﺩ؟
(B) .3ﻧﻔﻘﺎﺕ ﺗﻌﻠﻳﻡ ﺟﺎﻣﻌﻲ ﺃﻭ ﺑﻌﺩ ﺛﺎﻧﻭﻱ ﻣﺩﻓﻭﻋﺔ ﺑﺎﻟﻧﻳﺎﺑﺔ ﻋﻧﻙ ﺃﻭ ﻋﻥ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ ﺃﻭ ﻣﻥ ﺗﻌﻳﻠﻬﻡ؟ )ﺍﻹﺳﺗﻣﺎﺭﺓ (1098T
ﻓﻭﺍﺋﺩ ﺭﻫﻥ ﻣﻧﺯﻝ )ﺍﻹﺳﺗﻣﺎﺭﺓ (1098
ﻁﺏ ﻭﻁﺏ ﺃﺳﻧﺎﻥ )ﺑﻣﺎ ﻓﻳﻬﺎ ﺃﻗﺳﺎﻁ ﺍﻟﺗﺄﻣﻳﻥ(
(A) .4ﺃﻱ ﻣﻣﺎ ﻳﻠﻲ؟
ﻣﺳﺎﻫﻣﺎﺕ ﺧﻳﺭﻳﺔ
ﺿﺭﺍﺋﺏ )ﻭﻻﻳﺔ ،ﻋﻘﺎﺭﻳﺔ ،ﻣﻠﻛﻳﺔ ﺷﺧﺻﻳﺔ ،ﻣﺑﻳﻌﺎﺕ(
(B) .5ﻧﻔﻘﺎﺕ ﺭﻋﺎﻳﺔ ﺍﻷﻁﻔﺎﻝ/ﺍﻟﻌﺎﻟﺔ ،ﻣﺛﻝ ﺍﻟﺭﻋﺎﻳﺔ ﺍﻟﻳﻭﻣﻳﺔ؟
(B) .6ﻟﻠﻣﺳﺗﻠﺯﻣﺎﺕ ﺍﻟﻣﺳﺗﺧﺩﻣﺔ ﻛﺎﺧﺻﺎﺋﻲ ﺗﻌﻠﻳﻡ ﻣﺅﻫﻝ ﻣﺛﻝ ﺍﻟﻣﻌﻠﻡ ،ﺃﻭ ﻣﺳﺎﻋﺩ ﺍﻟﻣﻌﻠﻡ ﺃﻭ ﺍﻟﻣﺳﺗﺷﺎﺭ ﺃﻭ ﺇﻟﺦ.؟
(A) .7ﺍﻟﻧﻔﻘﺎﺕ ﺍﻟﻣﺗﻌﻠﻘﺔ ﺑﺩﺧﻝ ﺍﻟﻌﻣﻝ ﺍﻟﺣﺭ ﺃﻭ ﺃﻱ ﺩﺧﻝ ﺁﺧﺭ ﺗﻠﻘﻳﺗﻪ؟
(B) .8ﻓﺎﺋﺩﺓ ﻋﻠﻰ ﻗﺭﻭﺽ ﺍﻟﻁﺎﻟﺏ؟ )ﺍﻹﺳﺗﻣﺎﺭﺓ (1098E
ﻏﻳﺭ ﻭﺍﺛﻖ ﺍﻟﺟﺯء ﺍﻟﺧﺎﻣﺱ -ﺃﺣﺩﺍﺙ ﺍﻟﺣﻳﺎﺓ -ﻓﻲ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ ،ﻫﻝ ﺃﻧﺕ )أو زوﺟﺘﻚ/زوﺟﻚ(
(HSA) .1ﻛﺎﻥ ﻟﺩﻳﻙ ﺣﺳﺎﺏ ﺗﻭﻓﻳﺭ ﺻﺣﻲ؟ )ﺍﻹﺳﺗﻣﺎﺭﺍﺕ 5498SAﻭ 1099SAﻭ W-2ﻣﻊ ﺍﻟﺭﻣﺯ Wﻓﻲ ﺍﻟﻣﺭﺑﻊ (12
(A) .2ﻛﺎﻥ ﻟﺩﻳﻙ ﺩﻳﻥ ﻣﻥ ﺑﻁﺎﻗﺔ ﺇﺋﺗﻣﺎﻥ ﺃﻭ ﺭﻫﻥ ﻣﻠﻐﻰ/ﻣﻌﻔﻰ ﻣﻥ ﻗﺑﻝ ﻣﻘﺭﺽ ﺃﻭ ﻏﻠﻖ ﻟﺭﻫﻥ ﻣﻧﺯﻝ؟ )ﺍﻹﺳﺗﻣﺎﺭﺍﺕ (1099A ،1099C
(A) .3ﺗﺑﻧﻳﺕ ً
ﻁﻔﻼ؟
ﻻ
(B) .4ﻫﻝ ﻛﺎﻥ ﻟﺩﻳﻙ "ﺇﻋﺗﻣﺎﺩ ﺩﺧﻝ ﻣﻛﺗﺳﺏ" ] [Earned Income Creditﺃﻭ "ﺇﻋﺗﻣﺎﺩ ﺿﺭﻳﺑﺔ ﻁﻔﻝ" ] [Child Tax Creditﺃﻭ "ﺇﻋﺗﻣﺎﺩ ﻓﺭﺻﺔ ﺃﻣﺭﻳﻛﻳﺔ" ] [American Opportunity Creditﻏﻳﺭ
ﻣﺳﻣﻭﺡ ﻓﻲ ﺳﻧﺔ ﺳﺎﺑﻘﺔ؟ ﺇﺫﺍ ﻧﻌﻡ ،ﻷﻱ ﺳﻧﺔ ﺿﺭﻳﺑﻳﺔ؟
(A) .5ﻗﻣﺕ ﺑﺷﺭﺍء ﻭﺗﺭﻛﻳﺏ ﻣﺳﺗﻠﺯﻣﺎﺕ ﻣﻧﺯﻟﻳﺔ ﻣﻘﺗﺻﺩﺓ ﻟﻠﻁﺎﻗﺔ؟ )ﻣﺛﻝ ﻧﻭﺍﻓﺫ ،ﺳﺧﺎﻥ ،ﻣﻭﺍﺩ ﻋﺎﺯﻟﺔ ،ﺇﻟﺦ(.
(A) .6ﺗﻠﻘﻳﺕ "ﺇﻋﺗﻣﺎﺩ ﻣﺷﺗﺭﻱ ﺍﻟﻣﻧﺎﺯﻝ ﻟﻠﻣﺭﺓ ﺍﻷﻭﻟﻰ" ] [First Time Homebuyers Creditﻓﻲ ﺳﻧﺔ 2008؟
(B) .7ﺩﻓﻌﺕ ﺃﻗﺳﺎﻁ ﺿﺭﺍﺋﺏ ﻣﻘﺩﺭﺓ ﺃﻭ ﻁﺑﻘﺕ ﺍﻟﻣﺑﻠﻎ ﺍﻟﻣﺳﺗﺭﺟﻊ ﻣﻥ ﺍﻟﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ ﻋﻠﻰ ﺿﺭﻳﺑﺗﻙ ﻟﻬﺫﻩ ﺍﻟﺳﻧﺔ؟ ﺇﻥ ﻛﺎﻧﺕ ﺍﻟﺣﺎﻟﺔ ﻛﺫﻟﻙ ،ﻓﻛﻡ؟
(A) .8ﺭﻓﻌﺕ ﻛﺷﻑ ﺿﺭﺍﺋﺏ ﻓﺩﺭﺍﻟﻳﺔ ﻟﻠﺳﻧﺔ ﺍﻟﻣﺎﺿﻳﺔ ﻳﺣﺗﻭﻱ ﻋﻠﻰ "ﻣﺟﻣﻭﻉ ﻣﺭﺣﻝ ﻟﺧﺳﺎﺋﺭ ﺭﺃﺳﻣﺎﻟﻳﺔ" ] [capital loss carryoverﻋﻠﻰ ﺍﻟﻣﻠﺣﻖ Dﻣﻥ ﺍﻹﺳﺗﻣﺎﺭﺓ 1040؟
(A) .9ﻟﺩﻳﻙ ﺗﻐﻁﻳﺔ ﺻﺣﻳﺔ ﻣﻥ ﺧﻼﻝ ﺍﻟﺳﻭﻕ )ﺍﻟﺑﻭﺭﺻﺔ(؟ [ﻗﺩﻡ ﺍﻟﻧﻣﻭﺫﺝ ][A-1095
ﺍﻟﻛﺗﺎﻟﻭﺝ ﺭﻗﻡ 58970P
www.irs.gov
)(AR) (Rev. 10-2019
Form 13614-C
ﺍﻟﺻﻔﺣﺔ 3
ﻣﻌﻠﻭﻣﺎﺕ ﺇﺿﺎﻓﻳﺔ ﻭﺃﺳﺋﻠﺔ ﻣﺗﻌﻠﻘﺔ ﺑﺈﻋﺩﺍﺩ ﻛﺷﻑ ﺿﺭﺍﺋﺑﻙ
ﺯﻭﺩ ﻋﻧﻭﺍﻥ ﺑﺭﻳﺩ ﺇﻟﻛﺗﺭﻭﻧﻲ )ﺧﻳﺎﺭﻱ( )ﻟﻥ ﻳُﺳﺗﺧﺩﻡ ﻋﻧﻭﺍﻥ ﻫﺫﺍ ﺍﻟﺑﺭﻳﺩ ﺍﻹﻟﻛﺗﺭﻭﻧﻲ ﻟﻺﺗﺻﺎﻻﺕ ﻣﻥ ﻣﺻﻠﺣﺔ ﺿﺭﻳﺑﺔ ﺍﻟﺩﺧﻝ(
ّ .1
.2ﺻﻧﺩﻭﻕ ﺣﻣﻠﺔ ﺍﻹﻧﺗﺧﺎﺑﺎﺕ ﺍﻟﺭﺋﺎﺳﻳﺔ )ﺇﻥ ﺍﺧﺗﺭﺕ ﻣﺭﺑﻌﺎً ،ﻟﻥ ﻳﺣﺩﺙ ﺗﻐﻳﻳﺭﺍ ً ﻓﻲ ﺿﺭﻳﺑﺗﻙ ﻭﻻ ﻓﻲ ﺍﻟﻣﺑﻠﻎ ﺍﻟﻣﺳﺗﺭﺟﻊ ﻟﻙ(.
ﺍﺧﺗﺭ ﺍﻟﻣﺭﺑﻊ ﻫﻧﺎ ﺇﻥ ﻛﻧﺕ ﺃﻧﺕ ،ﺃﻭ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ ﻓﻲ ﺣﺎﻝ ﺭﻓﻊ ﻛﺷﻑ ﻣﺷﺗﺭﻙ ،ﺗﺭﻳﺩ ﺃﻥ ﻳﺧﺻﺹ ﻣﺑﻠﻎ $3ﻟﻬﺫﺍ ﺍﻟﺻﻧﺩﻭﻕ
ﺃﻧﺕ
ﺃ .ﺇﻳﺩﺍﻋﺎ ً ﻣﺑﺎﺷﺭﺍ ً
ﺏ .ﺷﺭﺍء ﺳﻧﺩﺍﺕ ﺗﻭﻓﻳﺭ ﺃﻣﺭﻳﻛﻳﺔ
.3ﺇﻥ ﻛﻧﺕ ﺗﺳﺗﺣﻖ ﻣﺑﻠﻐﺎ ً ﻣﺳﺗﺭﺟﻌﺎً ،ﻫﻝ ﺗﻭﺩ
ﻻ
ﻧﻌﻡ
ﻻ
ﻧﻌﻡ
.4ﺇﻥ ﻛﺎﻥ ﻟﺩﻳﻙ ﺭﺻﻳﺩ ﻣﺳﺗﺣﻖ ،ﻫﻝ ﺗﻭﺩ ﺩﻓﻊ ﻣﺑﻠﻎ ﻣﻥ ﺣﺳﺎﺑﻙ ﺍﻟﻣﺻﺭﻓﻲ؟
ﻻ
ﻧﻌﻡ
.5ﺗﻌﻳﺵ ﻓﻲ ﻣﻧﻁﻘﺔ ﺗﻡ ﺍﻹﻋﻼﻥ ﻋﻧﻬﺎ ﺑﺻﻔﺗﻬﺎ ﻣﻧﻁﻘﺔ ﻛﻭﺍﺭﺙ ﻓﻳﺩﺭﺍﻟﻳﺔ؟
ﻻ
ﻧﻌﻡ
ﺇﺫﺍ ﻛﺎﻧﺕ ﺍﻹﺟﺎﺑﺔ ﻧﻌﻡ ،ﻓﺄﻳﻥ؟
ﻻ
ﻧﻌﻡ
.6ﻫﻝ ﺃﻧﺕ ﺃﻭ ﺯﻭﺟﻙ/ﺯﻭﺟﺗﻙ ﻋﻧﺩ ﺍﻟﺗﺳﺟﻳﻝ ﻣﺗﺿﺎﻣﻧﻳﻥ ﺗﻠﻘﻳﺕ ﺧﻁﺎﺏ ﻣﻥ IRS؟
ﺍﻟﺯﻭﺟﺔ/ﺍﻟﺯﻭﺝ
ﺝ .ﻗﺳﻡ ﺍﻟﻣﺑﻠﻎ ﺍﻟﻣﺳﺗﺭﺟﻊ ﻟﻙ ﺑﻳﻥ ﺣﺳﺎﺑﺎﺕ ﻣﺧﺗﻠﻔﺔ
ﻻ
ﻧﻌﻡ
ﺗﻌﻣﻝ ﻣﻭﺍﻗﻊ ﻋﺩﻳﺩﺓ ﻹﻋﺩﺍﺩ ﻛﺷﻭﻑ ﺍﻟﺿﺭﺍﺋﺏ ﻋﺑﺭ ﺍﺳﺗﻼﻡ ﺃﻣﻭﺍﻝ ﻣﻧﺢ ﺃﻭ ﻏﻳﺭ ﺫﻟﻙ ﻣﻥ ﺍﻟﻣﺳﺎﻋﺩﺍﺕ ﺍﻟﻣﺎﻟﻳﺔ ﺍﻟﻔﻳﺩﺭﺍﻟﻳﺔ .ﻭﻗﺩ ﻳُﺳﺗﺧﺩﻡ ﺍﻟﺗﺎﺭﻳﺦ ﺑﺩ ًء ﻣﻥ ﺍﻷﺳﺋﻠﺔ ﺍﻟﺗﺎﻟﻳﺔ ﻣﻥ ﻗﺑﻝ ﻫﺫﺍ ﺍﻟﻣﻭﻗﻊ ﻟﻠﺗﻘﺩﻡ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﻫﺫﻩ ﺍﻟﻣﻧﺢ ﺃﻭ ﻟﺩﻋﻡ ﺍﺳﺗﻣﺭﺍﺭ ﺍﻟﺣﺻﻭﻝ
ﻋﻠﻰ ﺍﻟﺗﻣﻭﻳﻝ .ﻭﺳﺗ ُﺳﺗﺧﺩﻡ ﺃﺟﻭﺑﺗﻙ ﻷﻏﺭﺍﺽ ﺇﺣﺻﺎﺋﻳﺔ ﻓﻘﻁ .ﻭﻫﺫﻩ ﺍﻷﺳﺋﻠﺔ ﺍﺧﺗﻳﺎﺭﻳﺔ.
ً
ً
ﺟﻳﺩ
ﻏﻳﺭ
ﺍﻹﻁﻼﻕ
ﻋﻠﻰ
ﻻ
ﻭﺍﻟﺗﻛﻠﻡ؟
ﺍﻟﻔﻬﻡ
ﻣﺳﺗﻭﻯ
.7ﻫﻝ ﻣﻥ ﺍﻟﻣﻣﻛﻥ ﺃﻥ ﺗﻘﻭﻝ ﺇﻧﻙ ﺗﺳﺗﻁﻳﻊ ﻣﺗﺎﺑﻌﺔ ﺣﺩﻳﺙ ﺑﺎﻹﻧﺟﻠﻳﺯﻳﺔ ،ﻣﻥ ﺣﻳﺙ
ﺃﻓﺿﻝ ﺍﻹﻣﺗﻧﺎﻉ ﻋﻥ ﺍﻹﺟﺎﺑﺔ
ﺟﻳﺩﺍ
ﺟﻳﺩ ﺟﺩﺍ
ﺟﻳﺩﺍ ً
ﺟﻳﺩ ﺟﺩﺍ ً
ﻏﻳﺭ ﺟﻳﺩ
ﻻ ﻋﻠﻰ ﺍﻹﻁﻼﻕ
.8ﻫﻝ ﻣﻥ ﺍﻟﻣﻣﻛﻥ ﺃﻥ ﺗﻘﻭﻝ ﺇﻧﻙ ﺗﺳﺗﻁﻳﻊ ﺃﻥ ﺗﻘﺭﺃ ﺻﺣﻳﻔﺔ ﻳﻭﻣﻳﺔ ﺃﻭ ﻛﺗﺎﺑﺎ ً ﺑﺎﻹﻧﺟﻠﻳﺯﻳﺔ؟
ﺃﻓﺿﻝ ﺍﻹﻣﺗﻧﺎﻉ ﻋﻥ ﺍﻹﺟﺎﺑﺔ
.9ﻫﻝ ﻟﺩﻳﻙ ﺃﻧﺕ ﺃﻭ ﺃﺣﺩ ﺃﻓﺭﺍﺩ ﺃﺳﺭﺗﻙ ﺍﻟﻣﻌﻳﺷﻳﺔ ﺇﻋﺎﻗﺔ؟
.10ﻫﻝ ﺃﻧﺕ ﺃﻭ ﺯﻭﺟﺗﻙ/ﺯﻭﺟﻙ ﻓﺭﺩ ﺳﺎﺑﻖ ﻓﻲ ﺍﻟﻘﻭﺍﺕ ﺍﻟﻣﺳﻠﺣﺔ ﺍﻷﻣﺭﻳﻛﻳﺔ
.11ﻋﺭﻗﻙ؟
ﺁﺳﻳﻭﻱ
ﻣﻥ ﺳﻛﺎﻥ ﺃﻣﺭﻳﻛﺎ ﺍﻷﺻﻠﻳﻳﻥ ﺃﻭ ﻣﻥ ﺳﻛﺎﻥ ﺃﻻﺳﻛﺎ ﺍﻷﺻﻠﻳﻳﻥ
.12ﻋﺭﻕ ﺯﻭﺟﻙ/ﺯﻭﺟﺗﻙ؟
ﺁﺳﻳﻭﻱ
ﻣﻥ ﺳﻛﺎﻥ ﺃﻣﺭﻳﻛﺎ ﺍﻷﺻﻠﻳﻳﻥ ﺃﻭ ﻣﻥ ﺳﻛﺎﻥ ﺃﻻﺳﻛﺎ ﺍﻷﺻﻠﻳﻳﻥ
ﻫﺳﺑﺎﻧﻲ ﺃﻭ ﻻﺗﻳﻧﻲ
.13ﺍﻷﺻﻝ ﺍﻟﻌﺭﻗﻲ
ﻫﺳﺑﺎﻧﻲ ﺃﻭ ﻻﺗﻳﻧﻲ
.14ﺍﻷﺻﻝ ﺍﻟﻌﺭﻗﻲ ﻟﺯﻭﺟﻙ/ﺯﻭﺟﺗﻙ؟
ﻧﻌﻡ
ﻧﻌﻡ
ﻻ
ﻻ
ﺃﻣﺭﻳﻛﻲ ﺃﺳﻭﺩ ﺃﻭ ﻣﻥ ﺃﺻﻝ ﺃﻓﺭﻳﻘﻲ
ﺃﻓﺿﻝ ﺍﻻﻣﺗﻧﺎﻉ ﻋﻥ ﺍﻹﺟﺎﺑﺔ
ﺃﻓﺿﻝ ﺍﻻﻣﺗﻧﺎﻉ ﻋﻥ ﺍﻹﺟﺎﺑﺔ
ﻣﻥ ﺳﻛﺎﻥ ﻫﺎﻭﺍﻱ ﺍﻷﺻﻠﻳﻳﻥ ﺃﻭ ﻣﻥ ﺳﻛﺎﻥ ﺟﺯﺭ ﺍﻟﻣﺣﻳﻁ ﺍﻟﻬﺎﺩﺉ
ﺃﺑﻳﺽ
ﺃﻓﺿﻝ ﺍﻻﻣﺗﻧﺎﻉ ﻋﻥ ﺍﻹﺟﺎﺑﺔ
ﻣﻥ ﺳﻛﺎﻥ ﻫﺎﻭﺍﻱ ﺍﻷﺻﻠﻳﻳﻥ ﺃﻭ ﻣﻥ ﺳﻛﺎﻥ ﺟﺯﺭ ﺍﻟﻣﺣﻳﻁ ﺍﻟﻬﺎﺩﺉ
ﺃﻣﺭﻳﻛﻲ ﺃﺳﻭﺩ ﺃﻭ ﻣﻥ ﺃﺻﻝ ﺃﻓﺭﻳﻘﻲ
ﺃﻓﺿﻝ ﺍﻻﻣﺗﻧﺎﻉ ﻋﻥ ﺍﻹﺟﺎﺑﺔ
ﻟﻳﺱ ﻫﺳﺑﺎﻧﻲ ﺃﻭ ﻻﺗﻳﻧﻲ
ﺃﻓﺿﻝ ﺍﻻﻣﺗﻧﺎﻉ ﻋﻥ ﺍﻹﺟﺎﺑﺔ
ﻟﻳﺱ ﻫﺳﺑﺎﻧﻲ ﺃﻭ ﻻﺗﻳﻧﻲ
ﺃﺑﻳﺽ
ﺃﻓﺿﻝ ﺍﻻﻣﺗﻧﺎﻉ ﻋﻥ ﺍﻹﺟﺎﺑﺔ
ﺗﻌﻠﻳﻘﺎﺕ ﺇﺿﺎﻓﻳﺔ
ﺇﺧﻁﺎﺭ ﻗﺎﻧﻭﻥ ﺍﻟﺧﺻﻭﺻﻳﺔ ﻭﻗﺎﻧﻭﻥ ﺗﺧﻔﻳﺽ ﺍﻟﻣﻌﺎﻣﻼﺕ ﺍﻟﻭﺭﻗﻳﺔ
ﻳﻠﺯﻣﻧﺎ "ﻗﺎﻧﻭﻥ ﺍﻟﺧﺻﻭﺻﻳﺔ" ] [Privacy Actﻟﻌﺎﻡ 1974ﺑﺄﻥ ﻧﻘﻭﻡ ،ﻋﻧﺩ ﻁﻠﺏ ﻣﻌﻠﻭﻣﺎﺕ ،ﺑﺈﺧﺑﺎﺭﻙ ﺑﺣﻘﻧﺎ ﻗﺎﻧﻭﻧﻳﺎ ً ﻓﻲ ﻁﻠﺏ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ،ﻭﻟﻣﺎﺫﺍ ﻧﻁﻠﺑﻬﺎ ،ﻭﻛﻳﻑ ﺳﻳﺗﻡ ﺇﺳﺗﺧﺩﺍﻣﻬﺎ .ﻛﻣﺎ ﻋﻠﻳﻧﺎ ﺃﻥ ﻧﺧﺑﺭﻙ ﺑﻣﺎ ﻗﺩ ﻳﺣﺩﺙ ﺇﻥ ﻟﻡ ﻧﺣﺻﻝ ﻋﻠﻳﻬﺎ ،ﻭﺑﻣﺎ ﺇﺫﺍ ﻛﺎﻧﺕ ﺇﺟﺎﺑﺗﻙ ﻁﻭﻋﻳﺔ ﺃﻭ ﺇﻟﺯﺍﻣﻳﺔ
ﻛﺷﺭﻁ ﻟﻠﺣﺻﻭﻝ ﻋﻠﻰ ﻓﺎﺋﺩﺓ .ﺣﻘﻧﺎ ﻗﺎﻧﻭﻧﻳﺎ ً ﻓﻲ ﻁﻠﺏ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﺧﺎﺿﻊ ﻟﻠﻔﻘﺭﺓ 301ﻣﻥ ﺍﻟﻌﻧﻭﺍﻥ 5ﻣﻥ ﻗﺎﻧﻭﻥ ﺍﻟﻭﻻﻳﺎﺕ ﺍﻟﻣﺗﺣﺩﺓ ] .[5 U.S.C. 301ﻧﺣﻥ ﻧﻁﻠﺏ ﻫﺫﻩ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﻟﻣﺳﺎﻋﺩﺗﻧﺎ ﻋﻠﻰ ﺍﻹﺗﺻﺎﻝ ﺑﻙ ﻓﻲ ﺷﺄﻥ ﻣﺻﻠﺣﺗﻙ ﻭ/ﺃﻭ ﻣﺷﺎﺭﻛﺗﻙ ﻓﻲ ﺑﺭﺍﻣﺞ ﻣﺗﻁﻭﻋﻲ ﻣﺻﻠﺣﺔ IRS
ﻹﻋﺩﺍﺩ ﻛﺷﻭﻑ ﺿﺭﺍﺋﺏ ﺍﻟﺩﺧﻝ ﻭﺑﺭﺍﻣﺞ ﺍﻟﺗﻭﻋﻳﺔ ﻭﺍﻟﺗﻭﺍﺻﻝ .ﻭﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﺍﻟﺗﻲ ﺗﻌﻁﻳﻬﺎ ﻗﺩ ﻳﺗﻡ ﺗﺯﻭﻳﺩﻫﺎ ﻵﺧﺭﻳﻥ ﻳﺗﻭﻟﻭﻥ ﺗﻧﺳﻳﻖ ﺍﻷﻧﺷﻁﺔ ﻭﺇﺟﺭﺍءﺍﺕ ﺍﻟﺗﻭﻅﻳﻑ ﻓﻲ ﻣﻭﺍﻗﻊ ﻟﻣﺗﻁﻭﻋﻲ ﺇﻋﺩﺍﺩ ﺍﻟﻛﺷﻭﻑ ﺃﻭ ﺃﻧﺷﻁﺔ ﺍﻟﺗﻭﺍﺻﻝ .ﻛﻣﺎ ﻗﺩ ﻳﺗﻡ ﺇﺳﺗﺧﺩﺍﻡ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﻟﻭﺿﻊ ﺿﻭﺍﺑﻁ ﻓﻌﺎﻟﺔ ﻭﺇﺭﺳﺎﻝ
ﻣﺭﺍﺳﻼﺕ ﻭﺍﻟﺗﻌﺭﻑ ﻋﻠﻰ ﺍﻟﻣﺗﻁﻭﻋﻳﻥ .ﺇﺟﺎﺑﺗﻙ ﻁﻭﻋﻳﺔ ،ﻟﻛﻥ ﺇﻥ ﻟﻡ ﺗﺯﻭﺩ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﺍﻟﻣﻁﻠﻭﺑﺔ ،ﻗﺩ ﻻ ﺗﺗﻣﻛﻥ ﻣﺻﻠﺣﺔ IRSﻣﻥ ﺇﺳﺗﺧﺩﺍﻣﻙ ﻟﻠﻣﺳﺎﻋﺩﺓ ﻓﻲ ﻫﺫﻩ ﺍﻟﺑﺭﺍﻣﺞ" .ﻗﺎﻧﻭﻥ ﺗﺧﻔﻳﺽ ﺍﻟﻣﻌﺎﻣﻼﺕ ﺍﻟﻭﺭﻗﻳﺔ" ] [Paperwork Reduction Actﻳﻠﺯﻡ ﻣﺻﻠﺣﺔ IRSﺑﻌﺭﺽ ﺭﻗﻡ
ﻣﺭﺍﻗﺑﺔ ﻣﻛﺗﺏ OMBﻋﻠﻰ ﻛﺎﻓﺔ ﻁﻠﺑﺎﺕ ﺍﻟﻣﻌﻠﻭﻣﺎﺕ ﺍﻟﻌﺎﻣﺔ .ﻭﺭﻗﻡ ﻣﺭﺍﻗﺑﺔ ﻣﻛﺗﺏ OMBﻟﻬﺫﻩ ﺍﻟﺩﺭﺍﺳﺔ ﻫﻭ .1964-1545 :ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﺫﻟﻙ ،ﺇﺫﺍ ﻛﺎﻧﺕ ﻟﺩﻳﻙ ﺃﻱ ﺗﻌﻠﻳﻘﺎﺕ ﻋﻠﻰ ﺍﻟﺗﻘﺩﻳﺭﺍﺕ ﺍﻟﺯﻣﻧﻳﺔ ﺍﻟﻣﺭﺗﺑﻁﺔ ﺑﻬﺫﻩ ﺍﻟﺩﺭﺍﺳﺔ ﺃﻭ ﺇﻗﺗﺭﺍﺣﺎﺕ ﺣﻭﻝ ﺗﺑﺳﻳﻁ ﻫﺫﻩ ﺍﻟﻌﻣﻠﻳﺔ ،ﻳﺭﺟﻰ ﻣﺭﺍﺳﻠﺔ
ﻣﺻﻠﺣﺔ ﺿﺭﻳﺑﺔ ﺍﻟﺩﺧﻝ ﻋﻠﻰ ﺍﻟﻌﻧﻭﺍﻥ.Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224 :
ﺍﻟﻛﺗﺎﻟﻭﺝ ﺭﻗﻡ 58970P
www.irs.gov
)(AR) (Rev. 10-2019
Form 13614-C
15080 (AR) Form
)ﻳﻭﻟﻳﻭ (2019
ﻭﺯﺍﺭﺓ ﺍﻟﻣﺎﻟﻳﺔ ﺍﻷﻣﺭﻳﻛﻳﺔ -ﺩﺍﺋﺭﺓ ﺿﺭﻳﺑﺔ ﺍﻟﺩﺧﻝ
ﻣﻭﺍﻓﻘﺔ ﻋﻠﻰ ﺍﻟﻛﺷﻑ ﻋﻥ ﻣﻌﻠﻭﻣﺎﺕ ﻛﺷﻭﻑ ﺍﻟﺿﺭﺍﺋﺏ
ﻟﻣﻭﻗﻌﻲ ﺑﺭﻧﺎﻣﺟﻲ VITA/TCEﻹﻋﺩﺍﺩ ﻛﺷﻭﻑ ﺍﻟﺿﺭﺍﺋﺏ
ﺍﻟﻜﺸﻒ ﺍﻟﻔﺪﺭﺍﻟﻲ:
ﻳﻠﺰﻡ ﺍﻟﻘﺎﻧﻮﻥ ﺍﻟﻔﺪﺭﺍﻟﻲ ﺑﺄﻥ ﻳﺘﻢ ﺗﺰﻭﻳﺪﻙ ﺑﺈﺳﺘﻤﺎﺭﺓ ﻫﺬﻩ ﺍﻟﻤﻮﺍﻓﻘﺔ .ﻭﻣﺎ ﻟﻢ ﻳﻜﻦ ﺫﻟﻚ ﻣﺼﺮﺣﺎ ً ﺑﻪ ﻗﺎﻧﻮﻧﺎً ،ﻓﺈﻧﻪ ﻻ ﻳﻤﻜﻨﻨﺎ ﺃﻥ ﻧﻜﺸﻒ ﺑﺪﻭﻥ ﻣﻮﺍﻓﻘﺘﻚ ﻋﻦ ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ
ﺿﺮﺍﺋﺒﻚ ﻷﻁﺮﺍﻑ ﺛﺎﻟﺜﺔ ﻹﻏﺮﺍﺽ ﻏﻴﺮ ﺇﻋﺪﺍﺩ ﻭﺭﻓﻊ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ .ﻭﺇﻥ ﻭﺍﻓﻘﺖ ﻋﻠﻰ ﺍﻟﻜﺸﻒ ﻋﻦ ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ ،ﻗﺪ ﻻ ﻳﺤﻤﻲ ﺍﻟﻘﺎﻧﻮﻥ ﺍﻟﻔﺪﺭﺍﻟﻲ
ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ ﻣﻦ ﺇﺳﺘﺨﺪﺍﻣﻬﺎ ﺃﻭ ﺗﻮﺯﻳﻌﻬﺎ ﺑﻌﺪ ﺫﻟﻚ.
ﻭﻟﺴﺖ ﻣﻠﺰﻣﺎ ً ﺑﺈﺳﺘﻜﻤﺎﻝ ﻫﺬﻩ ﺍﻹﺳﺘﻤﺎﺭﺓ ﻣﻦ ﺃﺟﻞ ﺗﻮﻛﻴﻠﻨﺎ ﺑﺨﺪﻣﺎﺕ ﺇﻋﺪﺍﺩ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ .ﻭﺇﻥ ﺣﺼﻠﻨﺎ ﻋﻠﻰ ﺗﻮﻗﻴﻌﻚ ﻋﻠﻰ ﻫﺬﻩ ﺍﻹﺳﺘﻤﺎﺭﺓ ﻣﻦ ﺧﻼﻝ ﺇﺷﺘﺮﺍﻁ ﺧﺪﻣﺎﺗﻨﺎ
ﻹﻋﺪﺍﺩ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ ،ﻓﻠﻦ ﺗﻜﻮﻥ ﻣﻮﺍﻓﻘﺘﻚ ﺻﺎﻟﺤﺔ .ﻭﺇﻥ ﻭﺍﻓﻘﺖ ﻋﻠﻰ ﺍﻟﻜﺸﻒ ﻋﻦ ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ ،ﺗﻜﻮﻥ ﻣﻮﺍﻓﻘﺘﻚ ﺻﺎﻟﺤﺔ ﺧﻼﻝ ﺍﻟﻤﺪﺓ ﺍﻟﺰﻣﻨﻴﺔ ﺍﻟﺘﻲ
ﺗﺤﺪﺩﻫﺎ .ﻭﺇﻥ ﻟﻢ ﺗﺤﺪﺩ ﻣﺪﺓ ﻣﻮﺍﻓﻘﺘﻚ ،ﺗﻜﻮﻥ ﻣﻮﺍﻓﻘﺘﻚ ﺻﺎﻟﺤﺔ ﻟﻤﺪﺓ ﺳﻨﺔ ﻭﺍﺣﺪﺓ ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻟﺘﻮﻗﻴﻊ.
ﺍﻟﺸﺮﻭﻁ:
ﻳﺴﻤﺢ "ﺍﻟﺘﺮﺣﻴﻞ ﺍﻟﺸﺎﻣﻞ" ] [Global Carry Forwardﻟﻠﺒﻴﺎﻧﺎﺕ ﻟﺸﺮﻛﺔ TaxSlayer LLCﺍﻟﻤﻘﺪﻣﺔ ﻟﺒﺮﻧﺎﻣﺞ ﻛﻤﺒﻴﻮﺗﺮ ﺍﻟﻀﺮﺍﺋﺐ ﻟﺒﺮﻧﺎﻣﺠﻲ VITA/TCEﺑﺄﻥ
ﺗﺼﺒﺢ ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ ﻣﺘﻮﻓﺮﺓ ﻷﻱ ﻣﻮﻗﻊ ﻣﺘﻄﻮﻋﻴﻦ ﻣﺸﺎﺭﻙ ﻓﻲ ﺑﺮﻧﺎﻣﺠﻲ VITA/TCEﻭﺗﺨﺘﺎﺭﻩ ﻹﻋﺪﺍﺩ ﻛﺸﻒ ﺿﺮﺍﺋﺐ ﻓﻲ ﺍﻟﻤﻮﺳﻢ ﺍﻟﺘﺎﻟﻲ ﻟﺮﻓﻊ ﻛﺸﻮﻑ
ً
ﻣﺴﺘﻜﻤﻼ ﺑﺒﻴﺎﻧﺎﺗﻚ
ﺍﻟﻀﺮﺍﺋﺐ .ﻭﻳﻌﻨﻲ ﺫﻟﻚ ﺃﻧﻚ ﺳﺘﺘﻤﻜﻦ ﻣﻦ ﺯﻳﺎﺭﺓ ﺃﻱ ﻣﻮﻗﻊ ﻣﺘﻄﻮﻋﻴﻦ ﺑﺈﺳﺘﺨﺪﺍﻡ ﺑﺮﻧﺎﻣﺞ TaxSlayerﺍﻟﺴﻨﺔ ﺍﻟﻘﺎﺩﻣﺔ ﻭﺟﻌﻞ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ ﻳﺼﺒﺢ
ﻟﻠﺴﻨﺔ ﺍﻟﺤﺎﻟﻴﺔ ،ﺑﺼﺮﻑ ﺍﻟﻨﻈﺮ ﻋﻦ ﻣﻜﺎﻥ ﺭﻓﻌﻚ ﻟﻜﺸﻒ ﺿﺮﺍﺋﺒﻚ ﻫﺬﻩ ﺍﻟﺴﻨﺔ .ﻭﺗﻜﻮﻥ ﻫﺬﻩ ﺍﻟﻤﻮﺍﻓﻘﺔ ﺻﺎﻟﺤﺔ ﺣﺘﻰ ۱۳ﻧﻮﻓﻤﺒﺮ .۲۰۲۱
ﻭﺗﺸﻤﻞ ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ ﺍﻟﻀﺮﺍﺋﺐ ﺍﻟﺘﻲ ﺳﻴﺘﻢ ﺍﻟﻜﺸﻒ ﻋﻨﻬﺎ ﻭﻻ ﺗﻘﺘﺼﺮ ﻋﻠﻰ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﺍﻟﺪﻳﻤﻮﻏﺮﺍﻓﻴﺔ ﻭﺍﻟﻤﺎﻟﻴﺔ ﻭﻏﻴﺮﻫﺎ ﻣﻦ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﺍﻟﺘﻲ ﻗﺪ ﺗﻜﺸﻒ ﻋﻦ ﻫﻮﻳﺘﻚ
ﺍﻟﺸﺨﺼﻴﺔ ﻭﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ ﻭﻣﺼﺎﺩﺭ ﺩﺧﻠﻚ ،ﻭﺍﻟﺘﻲ ﺗﻢ ﺇﺩﺧﺎﻟﻬﺎ ﺿﻤﻦ ﺑﺮﻧﺎﻣﺞ ﻛﻤﺒﻴﻮﺗﺮ ﺇﻋﺪﺍﺩ ﻛﺸﻒ ﺍﻟﻀﺮﺍﺋﺐ ﺑﻬﺪﻑ ﺇﻋﺪﺍﺩ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ .ﻭﺗﺸﻤﻞ ﻫﺬﻩ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ
ﺇﺳﻤﻚ ،ﻭﻋﻨﻮﺍﻧﻚ ،ﻭﺗﺎﺭﻳﺦ ﻭﻻﺩﺗﻚ ،ﻭﺭﻗﻢ ﻫﺎﺗﻔﻚ ،ﻭﺭﻗﻢ ﺿﻤﺎﻧﻚ ﺍﻹﺟﺘﻤﺎﻋﻲ ،ﻭﻭﺿﻊ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ ،ﻭﻣﻬﻨﺘﻚ ،ﻭﺇﺳﻢ ﻭﻋﻨﻮﺍﻥ ﺭﺏ ﻋﻤﻠﻚ ،ﻭﻣﺒﺎﻟﻎ ﻭﻣﺼﺎﺩﺭ ﺍﻟﺪﺧﻞ،
ﻭﺍﻟﻤﻘﺘﻄﻌﺎﺕ ﻭﺍﻟﺮﺻﺎﺋﺪ ﺍﻟﻤﻌﻠﻨﺔ ﺃﻭ ﺍﻟﻤﺘﻀﻤﻨﺔ ﻋﻠﻰ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ .ﻛﻤﺎ ﺗﺸﻤﻞ ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ ﺍﻟﻀﺮﺍﺋﺐ ﺍﻟﺘﻲ ﺳﻴﺘﻢ ﺍﻟﻜﺸﻒ ﻋﻨﻬﺎ ﺇﺳﻢ ﺃﻱ ﺃﺷﺨﺎﺹ ﻣﻌﺎﻟﻴﻦ
ﻭﻣﺬﻛﻮﺭﻳﻦ ﻋﻠﻰ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ ﻭﺭﻗﻢ ﺿﻤﺎﻧﻬﻢ ﺍﻹﺟﺘﻤﺎﻋﻲ ﻭﺗﺎﺭﻳﺦ ﻭﻻﺩﺗﻬﻢ ﻭﺻﻠﺔ ﺍﻟﻘﺮﺍﺑﺔ.
ﻭﻻ ﺗﻜﻮﻥ ﺑﺤﺎﺟﺔ ﺇﻟﻰ ﺗﺰﻭﻳﺪ ﻣﻮﺍﻓﻘﺔ ﻟﺸﺮﻳﻚ ﺑﺮﻧﺎﻣﺠﻲ VITA/TCEﺍﻟﺬﻱ ﻳﺘﻮﻟﻰ ﺇﻋﺪﺍﺩ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ ﻫﺬﻩ ﺍﻟﺴﻨﺔ .ﻭﺳﻴﺴﺎﻋﺪﻙ Global Carry Forwardﻓﻘﻂ
ﺇﻥ ﺯﺭﺕ ﺷﺮﻳﻜﺎ ً ﻣﺨﺘﻠﻔﺎ ً ﻣﻦ ﺑﺮﻧﺎﻣﺞ VITAﺃﻭ TCEﺍﻟﺴﻨﺔ ﺍﻟﻘﺎﺩﻣﺔ ﻭﻳﺴﺘﺨﺪﻡ .TaxSlayer
ﻗﴫ ﻣﺪة اﳌﻮاﻓﻘﺔ :ﺃﻧﺎ/ﻧﺤﻦ ﺩﺍﻓﻊ ﺍﻟﻀﺮﺍﺋﺐ ﻻ ﺃﺭﻏﺐ ﻓﻲ ﻗﺼﺮ ﻣﺪﺓ ﺍﻟﻤﻮﺍﻓﻘﺔ ﻋﻠﻰ ﺍﻟﻜﺸﻒ ﻋﻦ ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ ﺍﻟﻀﺮﻳﺒﺔ ﺑﺘﺎﺭﻳﺦ ﺃﺑﻜﺮ ﻣﻤﺎ ﻫﻮ ﻭﺍﺭﺩ ﺃﻋﻼﻩ ) ۱۳ﻧﻮﻓﻤﺒﺮ
.(۲۰۲۱ﻭﺇﻥ ﻛﻨﺖ ﺃﻧﺎ/ﻧﺤﻦ ﺃﺭﻏﺐ ﻓﻲ ﻗﺼﺮ ﻣﺪﺓ ﺍﻟﻤﻮﺍﻓﻘﺔ ﻋﻠﻰ ﺍﻟﻜﺸﻒ ﺑﺘﺎﺭﻳﺦ ﺃﺑﻜﺮ ،ﻓﺴﺄﺭﻓﺾ/ﻧﺮﻓﺾ ﺍﻟﻤﻮﺍﻓﻘﺔ.
ﺣﴫ ﻧﻄﺎق اﻟﻜﺸﻒ :ﺃﻧﺎ/ﻧﺤﻦ ﺩﺍﻓﻊ ﺍﻟﻀﺮﺍﺋﺐ ﻻ ﺃﺭﻏﺐ ﻓﻲ ﺣﺼﺮ ﻧﻄﺎﻕ ﺍﻟﻜﺸﻒ ﻋﻦ ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ ﺍﻟﻀﺮﻳﺒﺔ ﺑﺄﻛﺜﺮ ﻣﻤﺎ ﻫﻮ ﻭﺍﺭﺩ ﺃﻋﻼﻩ .ﻭﺇﻥ ﻛﻨﺖ ﺃﺭﻏﺐ/ﻧﺮﻏﺐ ﻓﻲ
ﺣﺼﺮ ﻧﻄﺎﻕ ﺍﻟﻜﺸﻒ ﻋﻦ ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ ﺍﻟﻀﺮﺍﺋﺐ ﺑﺄﻛﺜﺮ ﻣﻤﺎ ﻫﻮ ﻭﺍﺭﺩ ﺃﻋﻼﻩ ،ﻓﺴﺄﺭﻓﺾ/ﻧﺮﻓﺾ ﺍﻟﻤﻮﺍﻓﻘﺔ.
ﺍﻟﻤﻮﺍﻓﻘﺔ:
ﺃﻧﺎ/ﻧﺤﻦ ،ﺩﺍﻓﻊ ﺍﻟﻀﺮﻳﺒﺔ ،ﻗﺮﺃﺕ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﺃﻋﻼﻩ.
ﺃﻧﺎ/ﻧﺤﻦ ﺃﻭﺍﻓﻖ ﻋﻠﻰ ﺍﻟﻜﺸﻒ ﻋﻦ ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ ﺍﻟﻀﺮﻳﺒﺔ ﺍﻟﻤﻮﺻﻮﻑ ﻓﻲ ﺷﺮﻭﻁ Global Carry Forwardﺃﻋﻼﻩ ﻭﺃﺳﻤﺢ ﻟﻤﻌﺪ ﻛﺸﻒ ﺍﻟﻀﺮﺍﺋﺐ ﺑﺈﺩﺧﺎﻝ ﻛﻠﻤﺔ
ﺳﺮ ﻓﻲ ﺑﺮﻧﺎﻣﺞ ﻛﻤﺒﻴﻮﺗﺮ ﺇﻋﺪﺍﺩ ﻛﺸﻒ ﺍﻟﻀﺮﺍﺋﺐ ﺑﺎﻟﻨﻴﺎﺑﺔ ﻋﻨﻲ ﻹﺛﺒﺎﺕ ﺃﻧﻲ/ﺃﻧﻨﺎ ﺃﻭﺍﻓﻖ ﻋﻠﻰ ﺷﺮﻭﻁ ﻫﺬﺍ ﺍﻟﻜﺸﻒ.
ﺍﺳﻢ ﺩﺍﻓﻊ ﺍﻟﻀﺮﻳﺒﺔ ﺍﻟﺮﺋﻴﺴﻲ ﻣﻄﺒﻮﻋًﺎ ﻭﺗﻮﻗﻴﻌﻪ
ﺍﻟﺘﺎﺭﻳﺦ
ﺍﺳﻢ ﺩﺍﻓﻊ ﺍﻟﻀﺮﻳﺒﺔ ﺍﻟﺮﺋﻴﺴﻲ ﻣﻄﺒﻮﻋًﺎ ﻭﺗﻮﻗﻴﻌﻪ
ﺍﻟﺘﺎﺭﻳﺦ
ﺇﻥ ﻛﻨﺖ ﺗﻌﺘﻘﺪ ﺃﻧﻪ ﺗﻢ ﺍﻟﻜﺸﻒ ﻋﻦ ﻣﻌﻠﻮﻣﺎﺕ ﻛﺸﻒ ﺿﺮﺍﺋﺒﻚ ﺃﻭ ﺇﺳﺘﺨﺪﺍﻣﻬﺎ ﺑﺸﻜﻞ ﻏﻴﺮ ﻻﺋﻖ ﻭﻏﻴﺮ ﻣﺴﻤﻮﺡ ﺑﻤﻮﺟﺐ ﺍﻟﻘﺎﻧﻮﻥ ﺃﻭ ﺑﺪﻭﻥ ﺇﺫﻧﻚ ،ﻓﺒﺈﻣﻜﺎﻧﻚ ﺍﻹﺗﺼﺎﻝ
ﺑـ"ﺍﻟﻤﺤﻘﻖ ﺍﻟﻌﺎﻡ ﻹﺩﺍﺭﺓ ﺍﻟﻀﺮﻳﺒﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﻤﺎﻟﻴﺔ" ] (Treasury Inspector General for Tax Administration] (TIGTAﻋﺒﺮ ﺍﻟﻬﺎﺗﻒ ﻋﻠﻰ ﺍﻟﺮﻗﻢ
1-800-366-4484ﺃﻭ ﻋﺒﺮ ﺍﻟﺒﺮﻳﺪ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ﻋﻠﻰ ﺍﻟﻌﻨﻮﺍﻥ [email protected]
ﺍﻟﻛﺗﺎﻟﻭﺝ ﺭﻗﻡ 71516X
www.irs.gov
)(AR) (Rev. 7-2019
Form 15080
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |