Form 4563 - Exclusion Of Income For Bona Fide Residents Of American Samoa (Page 2 of 2) in pdf

Form 4563 (Rev. 10-96)

Page

Who Qualifies

Income You Must Report on Form 1040

You qualify for the exclusion if you were a bona fide resident

You must report on Form 1040 your worldwide income for

of American Samoa for the entire tax year. See Bona Fide

the tax year that does not qualify for the exclusion. The

Residence Test below.

source of that income does not matter.

Note: In future years, bona fide residents of Guam and the

Deductions and Credits You May Not Take

Commonwealth of the Northern Mar iana Islands ( CNMI) may

on Form 1040

also qualify for the exclusion. They will not qualify, however,

unless implementation agreements are in effect with the

If you claim the exclusion, you may not take any deduction

United States. At the time this form went to print, the CNMI

or credit on Form 1040 that is definitely related to the

had not entered into an implementation agreement. Also, the

excluded income.

effective date of the agreement between the United States

Deductions and credits that are not definitely related to

and Guam had not been determined.

any particular type of income must be allocated between

Bona Fide Residence Test

your excludable income and your other income to find the

amount you may take on Form 1040. Examples of

To qualify under this test, you must be a bona fide resident

deductions that are not definitely related to any particular

of American Samoa for an uninterrupted period that includes

type of income are:

a complete tax year (January 1–December 31 if you file a

calendar year return).

The standard deduction, and

No specific rule determines if you are a bona fide resident

Certain itemized deductions such as medical and dental

of American Samoa. At the time this form went to print,

expenses, gifts to charity, and real estate taxes and

regulations defining the bona fide residence test under

mortgage interest on your personal residence.

section 931 had not been published. The following factors

For more details, including how to figure the amount

may be considered:

allocable to the excluded income, see Pub. 570.

Intent,

Note: Generally, you may take a deduction for each

Establishment of a permanent home,

exemption you are entitled to claim. This deduction is not

considered allocable to the excluded income.

Assimilation into the social, cultural, and economic

environment, and

Self-Employed Individuals

Physical presence.

If you were self-employed and your net earnings from self-

Other factors that may be considered are the nature,

employment were $400 or more, you will generally have to

extent, and reasons for temporary absences; assumption of

pay self-employment tax on those earnings even though you

economic burdens and payment of taxes to American

may exclude them from your gross income. Use Schedule

Samoa; existence of other homes outside American Samoa;

SE (Form 1040) to figure any self-employment tax due.

and place of employment.

Where To File

What Income May Be Excluded

Mail your return to the Internal Revenue Service Center,

If you qualify, you may exclude the following:

Philadelphia, PA 19255-0002, U.S.A.

Income received from sources in American Samoa, Guam,

Note: If you do not qualify for the exclusion, follow the

and the CNMI, and

Instructions for Form 1040. Report all your taxable income,

Income effectively connected with the conduct of a trade

including income from U.S., foreign, and possession sources.

or business in those possessions.

File your return with the Internal Revenue Service Center

shown in the Form 1040 instructions for the place where

For details on how to determine the source of income, see

you live.

Pub. 570, Tax Guide for Individuals With Income From U.S.

Possessions.

Employees of the United States

You may not exclude amounts paid to you for services you

performed as an employee of the U.S. Government or any of

its agencies. This rule applies to both civilian and military

employees.

Form 4563 - Exclusion Of Income For Bona Fide Residents Of American Samoa Page 2

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