Form 1040nr-Ez - U.s. Income Tax Return For Certain Nonresident Aliens With No Dependents - Dpeartment Of The Treasury

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1040NR-EZ
OMB No. 1545-0074
U.S. Income Tax Return for Certain
Form
Nonresident Aliens With No Dependents
2009
Department of the Treasury
Internal Revenue Service
Your first name and initial
Last name
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.
Please
print or
City, town or post office, state, and ZIP code. If you have a foreign address, see page 4.
type.
Country
Filing Status
1
Single nonresident alien
2
Married nonresident alien
Check only one box.
3
3
Wages, salaries, tips, etc. Attach Form(s) W-2 (see pages 4 and 5)
4
4
Taxable refunds, credits, or offsets of state and local income taxes (see page 5)
Attach
5
5
Scholarship and fellowship grants. Attach Form(s) 1042-S or required statement (see page 5)
Forms
6
6
Total income exempt by a treaty from page 2, Item J(1)(e)
W-2 or
7
7
Add lines 3, 4, and 5
1042-S
8
8
Scholarship and fellowship grants excluded (see page 6)
here.
9
9
Student loan interest deduction (see page 6)
Also
10
attach
10
Subtract the sum of line 8 and line 9 from line 7. This is your adjusted gross income
11
Form(s)
11
Itemized deductions (see page 7)
1099-R if
12
12
Subtract line 11 from line 10
tax was
13
13
Exemption (see page 7)
withheld.
14
14
Taxable income. Subtract line 13 from line 12. If line 13 is more than line 12, enter -0-
15
15
Tax. Find your tax in the Tax Table on pages 17 through 25
16
a
4137
b
8919
16
Unreported social security and Medicare tax from Form:
Enclose,
17
17
Add lines 15 and 16. This is your total tax
but do not
18
18
Federal income tax withheld (from Forms W-2, 1042-S, and 1099-R)
attach, any
19
19
2009 estimated tax payments and amount applied from 2008 return
payment.
20
20
Credit for amount paid with Form 1040-C
21
Add lines 18 through 20. These are your total payments
21
22
22
If line 21 is more than line 17, subtract line 17 from line 21. This is the amount you overpaid
Refund
23a
Amount of line 22 you want refunded to you.
If Form 8888 is attached, check here
23a
Direct
c
Type:
Checking
Savings
deposit? See
b
Routing number
page 8 and
d
Account number
fill in 23b,
e If you want your refund check mailed to an address outside the United States not
23c, and
shown above, enter that address here:
23d, or
Form 8888.
24
Amount of line 22 you want applied to your 2010 estimated tax
24
Amount
25
25
Amount you owe. Subtract line 21 from line 17. For details on how to pay, see page 9
You Owe
26
Estimated tax penalty (see page 9). Also include on line 25
26
Do you want to allow another person to discuss this return with the IRS (see page 10)?
Yes. Complete the following.
No
Third
Party
Personal identification
Designee
Designee’s
Phone
(
)
name
no.
number (PIN)
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Sign
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
Here
preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature
Date
Your occupation in the United States
Keep a copy of
this return for
your records.
Date
Preparer’s SSN or PTIN
Preparer’s
Paid
Check if
signature
self-employed
Preparer’s
Firm’s name (or
EIN
Use Only
yours if self-employed),
Phone no.
(
)
address, and ZIP code
1040NR-EZ
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 15.
Cat. No. 21534N
Form
(2009)

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