Hows GLACIER at = Tax Summary Report EME cen Sa Sendiva Rarbarpa srero-o% sony kambampat oma com County of Tax Residence: ira ‘Country of Citizenship: nia Current immigration Status: J Research Schoar Date of Enty to US: Novorbo 1.2018 Changed immigration Status? No 2018-250 Days 2018-262 Days 2014 340 Daye 2013-135 Days Immigration Status Expiration: Ociober 14, 2021 Immigration Status Change Date: Original immigration Status UCSD ID number: 4s22s2 Estimated Date of Departure: October 14,2021 Residency Status: Noneslgen Aion oc U.S. Tax Pose Residency Status Change Date: June 18, 2017 toResident Alen Residency Status Start Date: Janu 1, 2017 t cadet Alen Tisidency Siaus Change Date2 if appcabe): Residency Status Start Date 2 i appt): Saayagentions “Applicable Tax Witholding Rate: Single, 1(vontiy (i Tax Treaty Boos Not Apply or Frm I Not Suited) Tax Treaty Exemption Status: Taxable ‘Tax Treaty Time Limit: Not Applicable TAX Tax Treaty Exemption Period: Not Appia Tax Treaty Doar Limit:_ Nt Asosbie FICA Tax Status: Bona FICA Tax StartiChange Da Meee ee | Please copy and submit with Tax Summary Report i Please print, sign and submit with Tax Summary Report Required Forms: | Required Document Copies: Fon Wee | om ato Gna Sine Tax Form | Fomos-aore Visa Sticker'Starp (r Passpon) hereby declare that he information proved by me to Unversy of Calfomia, San Olego andlor entered into the GLACIER Online Tax |Comptanco System for purposes of maxing the ax dlermietions above fs tuo and correct. Wary ofthe information provided changes ori lotner relevant intrmation Becomes avalabo, | wll nol Univerty of Catia, San Diag as son as possible so that his ormaten ano ny US. tax statue may be upcsed Signature: Be aclg— Date: Nov-14-20) 6 “Tro informaton covtsined on ts statement was generated using GLACIER™ Online Tax Compance Sytem t1a16. "© Copyrgit Arete Intemational LLG” Alright roservod