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Department of State Division of Publications For Department of State Use Only 05--11-- I y Sequence Number: 312 Rosa L. Parks Avenue, 8th Floor Snodgrass/TN Tower Nashville, TN 37243 Phone: 615-741-2650
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Start by entering the day of the month in the first two digits. For example, if the date is May 11th, write "05" in the first two spaces.
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Next, fill in the month using the next two digits. In this case, write "11" for November.
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Finally, write the last two digits of the year. If the year is 2021, write "21" in the last two spaces.

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05--11-- i y is a form used for reporting information related to income earned.
Individuals and businesses who have income that meets the filing requirements set by the tax authorities.
You can fill out 05--11-- i y by providing accurate and complete information about your income and any related deductions or credits.
The purpose of 05--11-- i y is to report income earned and calculate the amount of taxes owed.
Income, deductions, credits, and any other relevant financial information that is required for tax purposes.
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