Form 1040-C - U.s. Departing Alien Income Tax Return - 1998 Page 2
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2
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42
Form 1040-C (1998)
Page
Exemptions
Part II
Group I
—If you are a resident alien, you may claim the same exemptions allowed U.S. citizens on Form 1040.
Group II
—If you are a nonresident alien with income effectively connected with a U.S. business, you may claim one exemption. Residents of Canada,
India, Mexico, Japan, the Republic of Korea, or U.S. nationals (American Samoans), see page 3 of the instructions.
Group III
—If you are a nonresident alien with income not effectively connected with a U.S. business, do not claim any exemptions from that income.
14a
Yourself
b
Spouse
No. of boxes checked
Caution: If your parent (or someone else) can claim you as a dependent on his or her 1998 tax
on 14a and 14b . . .
return, do not check box 14a.
No. of your children
(3) Dependent’s
(4) No. of months
c
Dependents:
(2) Dependent’s social security
on 14c who:
relationship
lived in your
(1) First name
Last name
number
to you
home in 1998
lived with you. .
did not live with
you due to divorce
or separation . .
Dependents on 14c
not entered above
Add numbers entered
d
Total number of exemptions claimed
on lines above
Figuring Your Income Tax
Part III
15
15
Total income (from page 3, Schedule A, line 4, column (d) or (e))
16
16
Adjustments. See page 3 of the instructions and attach appropriate form or statement
17
17
Adjusted gross income. Subtract line 16 from line 15
18
18
Tax (from page 4, Schedule D, line 6 or 12, whichever applies)
19
19
Credits. See page 3 of the instructions and attach appropriate form or statement
20
20
Subtract line 19 from line 18. If zero or less, enter -0-
21
21
Other taxes. See page 3 of the instructions and attach appropriate form
22
Tax for Group I or II. Add lines 20 and 21
22
23
23
Total income (from page 3, Schedule A, line 4, column (f))
24
Tax (30% of line 23). If less than 30%, attach statement showing computation
24
25
Total tax. Add lines 22 and 24
25
26
U.S. income tax paid or withheld at source (from page 3, Schedule
26
A, line 4, column (c), or withheld from Forms W-2, W-2G, 1099-R, etc.)
27
27
Estimated U.S. income tax paid
28
28
Other payments (specify)
29
29
Total payments. Add lines 26 through 28
30
30
If line 25 is more than line 29, subtract line 29 from line 25. This is the Amount You Owe
31
If line 29 is more than line 25, subtract line 25 from line 29. This is the amount you Overpaid.
Any overpayment of tax will be refunded only when you file your final return for the tax year
31
Note: A Form 1040-C is not a final retur n. You must file a final income tax retur n on the correct for m after your nor mal tax year
ends. See Final Return Required on page 1 of the instructions.
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 complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any
Here
knowledge.
Keep a copy
of this return
Your signature
Date
Date
Spouse’s signature
for your
(A return made by an agent must be accompanied by a power of attorney.)
(If filing jointly, BOTH must sign even if only one had income.)
records.
Preparer’s social security number
Date
Preparer’s
Paid
Check if
signature
self-employed
Preparer’s
Firm’s name (or
EIN
yours if self-employed)
Use Only
ZIP code
and address
Certificate of Compliance
This certifies that the above individual(s) has satisfied all the requirements of the Internal Revenue Code and the Internal Revenue Regulations relating to departing
aliens according to all information available to me at this date. This certificate is effective for the tax period
beginning
, 1998, and ending
, 19
,
or the tax year ended
, 19
.
(District Director of Internal Revenue)
Date
, 19
By
(Name)
(Title)
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