Form 1040-C - U.s. Departing Alien Income Tax Return - 1998
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41040-C
U.S. Departing Alien Income Tax Return
OMB No. 1545-0086
Form
For tax period or year beginning
, 1998,
1998
and ending
, 19
Department of the Treasury
See separate instructions.
File original and one copy.
Internal Revenue Service
Your first name and initial
Last name
Your social security number
If a joint return, spouse’s first name and initial
Last name
Spouse’s social security number
Number, street, and apt. no. or rural route
Passport or alien registration card number
Date of departure
Your number
Spouse’s number
U.S. post office address (city or town, state, and ZIP code)
Name of carrier
Complete foreign address
Place of departure
Country of destination
Of what country are you a citizen or subject?
Of what country are you a resident?
Date on which you last arrived in the U.S.
A Is your employer willing to furnish a letter guaranteeing that the tax will be paid?
Yes
No
If “Yes,” please attach the letter and leave the remainder of this form blank except for the signature area on page 2.
Explanation of Status—Resident or Nonresident Alien
Part I
1
Check the correct box or boxes below:
Note: A nonresident alien who has income from real property may elect to treat this income as effectively connected income.
Gain or loss on the disposition of a U.S. real property interest by a nonresident alien is effectively connected income or
loss. For details, see the 1997 Form 1040NR instructions or Pub. 519, U.S. Tax Guide for Aliens.
Group I—Resident alien.
Group II—Nonresident alien with income effectively connected with a U.S. trade or business.
Group III—Nonresident alien with income not effectively connected with a U.S. trade or business.
2
Kind of trade or business or occupation in the United States
3
Visa number and class under which you were last admitted to the United States
4
Do you have a permit to reenter the United States?
Yes
No
If “Yes,” enter the expiration date
5
Have you signed a waiver of rights, privileges, exemptions, and immunities as described under Exceptions
on page 1 of the instructions?
Yes
No
If “Yes,” enter the date signed
6
If you were employed in the United States, did you file Form 1078, Certificate of Alien Claiming Residence
in the United States?
Yes
No
7
Have you applied for U.S. citizenship?
Yes
No
8
If you filed income tax returns in the United States, give the following information for 1997:
a
Your U.S. address shown on return
$
$
$
b
c
d
Taxable income reported
Tax paid
Balance due
9
Do you know of any current charges against you concerning your U.S. taxes for any tax period?
Yes
No
10
Do you plan to return to the United States?
Yes
No
If “Yes,” complete lines 11 through 13 below.
11
Are your spouse and any children remaining in the United States?
Yes
No
12
Show the approximate value and location in the United States of any property held by you:
Value
Location
$
;
a
Real property
$
;
$
b Stocks and bonds
;
$
;
c
Cash
$
;
d
Other (specify)
13
If you will not return before (a) the due date for filing a final U.S. income tax return for the current year, or (b) the due date
for filing a final U.S. income tax return for the preceding year, what arrangements have you made to file the final income tax
return(s) and pay the tax(es)?
1040-C
For Privacy Act and Paperwork Reduction Act Notice, see page 5 of instructions.
Cat. No. 11310F
Form
(1998)
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