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year for which you are requesting

required to have been filed by an

and one was not provided on the return

certification. For information on

individual requesting certification for

you filed, one will not be entered

determining your period of residency,

2012.

automatically. Form 6166 will only

see Pub. 519.

certify that you filed a return with a

Example 2. On May 1, 2012, the

particular NAICS code if it matches the

same Form 1040 filer would enter

Current year certification. If

NAICS code on your application. If you

201112 as the tax period for a

certification is requested for purposes

provide a code that does not match,

of claiming benefits under an income

certification year of 2011 (the 2011

Form 6166 will state that you represent

Form 1040 was required to have been

tax treaty or VAT exemption for any

that your NAICS code is as stated on

filed before May 1, 2012).

period during the current calendar year

Form 8802.

or a year for which a tax return is not

Example 3. On January 1, 2012, a

yet required to be filed with the IRS,

Form 1040 filer completing Form 8802

Line 10. Penalties of

penalties of perjury statement(s) will be

for a certification year of 2009 would

required from all applicants stating that

enter 200912.

Perjury Statements and

such applicant is a U.S. resident and

If you were not required to file a U.S.

will continue to be so throughout the

Attachments

tax return for the tax period for which

current tax year. See Table 2 for the

Penalties of perjury statements from

certification is requested, enter the tax

current year penalties of perjury

Table 2 may be entered in the space

period that would have been applicable,

statement you must enter on line 10 of

if you were required to file a U.S. tax

provided under line 10 or as an

Form 8802 or attach to the form.

return. After the tax period, add ‘‘(not

attachment to Form 8802. Penalties of

Note. For VAT certification, a

perjury statements submitted

required to file).’’

statement that the business activity has

independently of Form 8802 must have

not changed is also required. For more

Line 9. Purpose of

a valid signature and date. See Table

information, see the instructions for line

Certification

10 below.

VAT. For VAT certifications, the

You must indicate the purpose of the

Line 8. Tax Period(s)

penalties of perjury statement must also

certification.

include a statement that the business

If you are requesting certification for a

activity (NAICS code) has not changed

Your application will be returned

tax period for which a tax return is not

since your last filed return.

to you for completion if you do

yet due, enter the four-digit year and

not include a purpose on the

two-digit month (YYYYMM) that

CAUTION

Attachments. If any attachment is

application.

corresponds to the end of the most

submitted independently of Form 8802

recent tax period for which you filed a

Income tax treaty. If you are

and is prepared by someone other than

tax return. For a prior year certification,

requesting certification to obtain

the person signing Form 8802, the

the four-digit year and two-digit month

benefits under an income tax treaty but

attachment must be signed and dated

should correspond to the end of the

you have requested certification for a

under penalties of perjury by an

prior year tax period for which

non-treaty country, your application will

individual who has authority to sign

certification is requested.

be returned to you for correction.

Form 8802. See Table 3.

Example 1. A Form 1040 filer who

VAT. The North American Industry

Additional Information. If additional

is completing Form 8802 for

Classification System (NAICS) codes

information is required to be submitted

certification year 2012 on January 1,

can be found in the instructions for your

with Form 8802, use the space

2012, would enter 201012 on line 8.

tax return (for example, Form 1120 or

provided under line 10 or attach the

This is because on January 1, 2012,

Schedule C (Form 1040)). If you do not

information to the form.

the 2010 Form 1040 is the latest return

provide a NAICS code on Form 8802

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

an individual

the individual

the 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 activities

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

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

current tax year, and

each individual

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.

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Instructions For Form 8802 - Application For United States Residency Certification - 2012 Page 9

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