OMB No. 1545-0074
U.S. Income Tax Return for Certain
Nonresident Aliens With No Dependents
Department of the Treasury
Internal Revenue Service
Your first name and initial
Identifying number (see page 4)
Present home address (number, street, and apt. no., or rural route). If you have a P.O. box, see page 4.
City, town or post office, state, and ZIP code. If you have a foreign address, see page 4.
Single nonresident alien
Married nonresident alien
Check only one box.
Wages, salaries, tips, etc. Attach Form(s) W-2 (see pages 4 and 5)
Taxable refunds, credits, or offsets of state and local income taxes (see page 5)
Scholarship and fellowship grants. Attach Form(s) 1042-S or required statement (see page 5)
Total income exempt by a treaty from page 2, Item J(1)(e)
Add lines 3, 4, and 5
Scholarship and fellowship grants excluded (see page 6)
Student loan interest deduction (see page 6)
Subtract the sum of line 8 and line 9 from line 7. This is your adjusted gross income
Itemized deductions (see page 7)
Subtract line 11 from line 10
Exemption (see page 7)
Taxable income. Subtract line 13 from line 12. If line 13 is more than line 12, enter -0-
Tax. Find your tax in the Tax Table on pages 17 through 25
Unreported social security and Medicare tax from Form:
Add lines 15 and 16. This is your total tax
but do not
Federal income tax withheld (from Forms W-2, 1042-S, and 1099-R)
2009 estimated tax payments and amount applied from 2008 return
Credit for amount paid with Form 1040-C
Add lines 18 through 20. These are your total payments
If line 21 is more than line 17, subtract line 17 from line 21. This is the amount you overpaid
Amount of line 22 you want refunded to you.
If Form 8888 is attached, check here
page 8 and
fill in 23b,
e If you want your refund check mailed to an address outside the United States not
shown above, enter that address here:
Amount of line 22 you want applied to your 2010 estimated tax
Amount you owe. Subtract line 21 from line 17. For details on how to pay, see page 9
Estimated tax penalty (see page 9). Also include on line 25
Do you want to allow another person to discuss this return with the IRS (see page 10)?
Yes. Complete the following.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
and belief, they are true, correct, and accurately list all amounts and sources of U.S. source income I received during the tax year. Declaration of
preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your occupation in the United States
Keep a copy of
this return for
Preparer’s SSN or PTIN
Firm’s name (or
yours if self-employed),
address, and ZIP code
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 15.
Cat. No. 21534N