Antrag auf Behandlung als unbeschränkt einkommensteuer - Steuern

Affirmation<br />

Date<br />

D<br />

Section D has been left blank because a certification by the foreign tax auhority was submitted for one of the two previous assessment<br />

periods (calendar year ___________, tax number ______________________ ) and there has been no change in the relevant circumstances.<br />

(applicant’s signature) (spouse’s signature)<br />

Certification by the foreign tax authority:<br />

Name and address of the foreign tax authority<br />

It is hereby certified<br />

1. that the taxpayer(s) named on page 1 had his/her/their domicile in our country in calendar year 201__;<br />

2. that we have no knowledge of anything which contradicts the information supplied in this application concerning<br />

personal circumstances and income.<br />

The following person(s) helped fill out this application:<br />

Mr/Ms/Messrs<br />

Place Date Official stamp and signature

---

Affirmation<br />

Date<br />

D<br />

Section D has been left blank because a certification by the foreign tax auhority was submitted for one of the two previous assessment<br />

periods (calendar year ___________, tax number ______________________ ) and there has been no change in the relevant circumstances.<br />

(applicant’s signature) (spouse’s signature)<br />

Certification by the foreign tax authority:<br />

Name and address of the foreign tax authority<br />

It is hereby certified<br />

1. that the taxpayer(s) named on page 1 had his/her/their domicile in our country in calendar year 201__;<br />

2. that we have no knowledge of anything which contradicts the information supplied in this application concerning<br />

personal circumstances and income.<br />

The following person(s) helped fill out this application:<br />

Mr/Ms/Messrs<br />

Place Date Official stamp and signature