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O.S. No, this payment is exempt PAYEE S.E.D. A. If yes, is it made by direct deposit to an AP/B or IB account? AP B or IB C. What is the Payee's last name, middle initial and Social Security Number? S.P.N. R.V.T.D. A. What is the Payee's name, full name and other identifying information that this employer has about him/her? (Surname, maiden name, address, phone number, etc.) Note: The following information is required under the U.S. Internal Revenue Service rules of the Internal Revenue Code. The information you provide must be complete and not erroneous. If you use the information you have received from UH to obtain a refund or credit for a student fee that was paid in another state you must be sure to include your Social Security number, which the federal government will not accept. Failure to do so may result in the payment of no tax. You may not use the amount you have been reimbursed as a credit for any federal tax liability you may have. Payment: If no, why not submit your request for refund or an adjustment? If yes, please send your request to: Internal Revenue Service Payment, Refund and Adjustment Unit UH Alumni Association 541 East Third Street Hawaii Island 96707 Payment Request Form If you make the request from outside the United States be sure to include a copy of your tax return, a copy of your tax letter indicating the tax due and a copy of the original or certified copy of the tax certificate. A. You may not submit this information to UH without written permission of the Internal Revenue Service. Payment Method: This is done by credit or debit card.