Revenue Procedure 87-9

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For Teachers and Researchers claiming exemption under Article VI of the Income Tax Treaty Between the United States and Georgia.

First Name:

Last Name:

Social Security Number: 

I was a resident of Georgia on the date of my arrival in the Unites States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant.

I am visiting the United States for the purpose of teaching, giving lectures, or conducting research at Buffalo State, which is an accredited educational institution or scientific research institution. I will receive compensation for my teaching, lecturing, or research activities.

The teaching, lecturing, or research compensation received during the entire tax year or during the period
Select a date to Select a date qualifies for exemption from withholding of federal tax under the tax treaty between the United States and Georgia. I have not previously claimed an income tax exemption under that treaty for income received as a teacher, lecturer, researcher, or student before the date of my arrival in the United States.

Any research I perform will be undertaken in the public interest and not primarily for the private benefit of a specific person or persons.

I arrived in the United States Select a date (date of arrival). The treaty exemption is available only for compensation received for a period of two (2) years beginning on that date.

I certify that the information I have provided above is true, correct and complete and that the above statements apply to me.