Form 1040nr-Ez - U.s. Income Tax Return For Certain Nonresident Aliens With No Dependents - 2016

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1040NR-EZ
U.S. Income Tax Return for Certain
OMB No. 1545-0074
Form
Nonresident Aliens With No Dependents
2016
Department of the Treasury
Information about Form 1040NR-EZ and its instructions is at
Internal Revenue Service
Your first name and initial
Identifying number (see instructions)
Last name
Please print
Present home address (number, street, and apt. no., or rural route). If you have a P.O. box, see instructions.
or type.
See
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
separate
instructions.
Foreign country name
Foreign province/state/county
Foreign postal code
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 .
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4
4
Taxable refunds, credits, or offsets of state and local income taxes .
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5
Scholarship and fellowship grants. Attach Form(s) 1042-S or required statement.
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5
6
Total income exempt by a treaty from page 2, Item J(1)(e) .
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7
7
Add lines 3, 4, and 5
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Attach
8
Scholarship and fellowship grants excluded .
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8
Form(s)
9
Student loan interest deduction .
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9
W-2 or
10
Subtract the sum of line 8 and line 9 from line 7. This is your adjusted gross income
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1042-S
11
Itemized deductions (see instructions) .
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11
here.
12
Subtract line 11 from line 10 .
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12
Also
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Exemption (see instructions) .
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4050
attach
14
Taxable income. Subtract line 13 from line 12. If line 13 is more than line 12, enter -0-
14
Form(s)
15
Tax. Find your tax in the tax table in the instructions .
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15
1099-R if
tax was
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Unreported social security and Medicare tax from Form:
a
4137
b
8919
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withheld.
17
Add lines 15 and 16. This is your total tax .
17
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18a Federal income tax withheld from Form(s) W-2 and 1099-R
18a
b Federal income tax withheld from Form(s) 1042-S .
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18b
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2016 estimated tax payments and amount applied from 2015 return
20
Credit for amount paid with Form 1040-C
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21
Add lines 18a through 20. These are your total payments .
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21
22
If line 21 is more than line 17, subtract line 17 from line 21. This is the amount you overpaid
22
Refund
23a Amount of line 22 you want refunded to you. If Form 8888 is attached, check here
23a
b Routing number
c Type:
Checking
Savings
d Account number
Direct
e If you want your refund check mailed to an address outside the United States not
deposit?
shown above, enter that address here:
See
instructions.
24
Amount of line 22 you want applied to your 2017 estimated tax
24
Amount
25
Amount you owe. Subtract line 21 from line 17. For details on how to pay, see instructions
25
You Owe
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26
Estimated tax penalty (see instructions) .
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Third
Do you want to allow another person to discuss this return with the IRS (see instructions)?
Yes. Complete the following.
No
Party
Designee
Personal identification
Designee’s
Phone
number (PIN)
name
no.
Sign
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
Here
preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature
Date
Keep a copy of
Your occupation in the United States
If the IRS sent you an Identity Protection
this return for
PIN, enter it
your records.
here (see inst.)
Print/Type preparer’s name
Preparer’s signature
Date
PTIN
Paid
Check
if
self-employed
Preparer
Use Only
Firm’s name
Firm’s EIN
Firm’s address
Phone no.
1040NR-EZ
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.
Form
(2016)
Cat. No. 21534N

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