Instructions For Form 8802 - 2016 (Page 12 of 16) in pdf

statement you must enter on line 10 of

Attachments. If any attachment is

Additional information. If additional

Form 8802 or attach to Form 8802.

submitted independently of Form 8802

information is required to be submitted

and is prepared by someone other than

with Form 8802, use the space provided

Note. For a Form 8802 submitted after

the person signing Form 8802, the

under line 10 or attach the information to

the first year of the 3-year procedure,

attachment must be signed and dated

the form.

enter “See attached year 1 Form 8802

under penalties of perjury by an

filed under the 3-year procedure” in

individual who has authority to sign

place of the penalties of perjury

Form 8802. See Table 3.

statement on line 10.

Table 2. Current Year Penalties of Perjury Statements

THEN the Form

8802 penalties of

IF the applicant

perjury statement

STATING: “This certification is given under penalties of perjury and to the best of

is...

must include...

my knowledge and belief, the statements are true, correct, and complete.”

a statement from

[Insert name of individual and TIN] is a U.S. resident and will continue to be throughout the

an individual

the individual

current tax year.

an individual

a statement from

Countries other than Japan: [Insert name of individual and TIN] was a U.S. resident

claiming treaty

the individual

within the meaning of Article [#] of the U.S.-[country] treaty (including, in some cases,

benefits for

physical presence in the United States) immediately before entering [country]. The

teaching or

assignment began on [date] and ends on [date]. Article [#] of the U.S.-[country] treaty

research

provides a [2 or 3] year exemption from income tax.

activities

Japan: [Insert name of individual and TIN] is (and will continue to be) a U.S. resident

within the meaning of Article 4(1) of the U.S.-Japan treaty. The assignment began on

[date] and ends on [date]. Article 20 of the U.S.-Japan treaty provides a 2-year

exemption from income tax.

a partnership

a statement from

[Insert name of partner and TIN] is a U.S. resident and will continue to be throughout the

each individual

current tax year, and

partner for which

certification is

requested

a statement from a

[Insert name of partnership and EIN] has filed its required return and the entity

general partner

classification has not changed since the return was filed.

a statement from

[Insert name of shareholder and TIN] is a U.S. resident and will continue to be throughout

each individual

the current tax year, and

an S corporation

shareholder for

which certification

is requested

a statement from

[Insert name of S corporation and EIN] has filed its required return and the entity

an officer of the

classification has not changed since the return was filed.

corporation with the

authority to legally

bind the corporation

a statement from

[Insert name and TIN] is a U.S. resident and will continue to be throughout the current tax

a common trust

each

individual

year, and

fund, grantor

participant/owner/

trust, or simple

beneficiary

for

trust

which certification

is requested

a statement from

[Insert name of trust and EIN] has filed its required return and the entity classification has

the trustee with

not changed since the return was filed.

authority to legally

Note: When the participant, beneficiary, or owner, is other than an individual, use the

bind the trust

statement that corresponds to the type of entity.

a statement from

[Insert name of trust and EIN] is a U.S. resident and will continue to be throughout the

the trustee with

current tax year.

a trust

authority to legally

bind the trust

-12-

Instructions for Form 8802 (Rev. 10-2017)

Instructions For Form 8802 - 2016 Page 12

Related Articles

Related forms

Related Categories