Form 1040-C - U.s. Departing Alien Income Tax Return

Form 1040-C (1998)

Page

Schedule A

Income (Do not include exempt income on lines 1 through 4.)

Nonresident alien income

(b) Type of income (such as

(d) Resident alien

salary, wages, taxable

(e) Effectively

(f) Not effectively

(a) Payer of income

income tax paid or

income

interest, dividends, rents,

connected with a U.S.

withheld at source

alimony received, etc.)

trade or business*

trade or business**

2 Net gain, if any, from Schedule D (Form 1040)

3 Net gain, if any, from Schedule B, line 2

4 Totals

5 Tax-exempt interest income. Do not include on line 4

Enter in column (e): (1) salary and wages as shown on Form W-2; (2) net income from the operation of a business from separate Schedule C (Form 1040),

Schedule C-EZ (Form 1040), or other appropriate business schedule; and (3) any other income effectively connected with a U.S. trade or business.

** Including alimony received.

Include any U.S. income tax that was paid or withheld on income in column (c), lines 1 through 3.

Schedule B

Gains and Losses From Sales or Exchanges of Nonresidents’ Property Not Effectively

Connected With a U.S. Trade or Business (Capital gains and income other than capital gains)

You must complete this schedule if you are a nonresident alien with gains from the sale or exchange of property (except U.S. real property

interests) from sources in the United States that are not effectively connected with a U.S. trade or business. Include any U.S. income tax that

was paid or withheld on these gains on Schedule A, column (c), line 3.

(a) Description of property

(b) Date acquired

(e) Cost or other

(f) Gain or (loss)

(If necessary, attach statement of

(d) Sales price

(mo., day, yr.)

basis

subtract (e) from (d)

descriptive details not shown below.)

Net gain. Enter on Schedule A, line 3, column (f)

Schedule C

Itemized Deductions

If you are a resident alien reporting income on Schedule A, column (d), you may claim the same deductions allowable on Schedule

A (Form 1040).

If you are a nonresident alien reporting income on Schedule A, column (e), you may claim only deductions that are connected

to U.S. trade or business income and not deducted elsewhere. See Schedule A (Form 1040NR). You should file Form 4684,

Casualties and Thefts, to support casualty or theft losses shown below. Casualty or theft losses and charitable contributions do

not have to be related to U.S. trade or business income.

If you are a nonresident alien reporting income on Schedule A, column (f), do not claim any deductions related to that income.

(a) Type of deduction

(b) Amount

(d) Amount of

(such as interest, taxes, contributions, etc.)

of deduction

(such as interest, taxes, contributions, etc.)

deduction

Total itemized deductions. Add the amounts in columns (b) and (d) of line 1. Enter the total here

and on Schedule D, line 2 or line 8, whichever applies. Exception. If the amount on Form 1040-C,

line 17, is over $124,500 ($62,250 if married filing separately), see page 5 of the instructions for

the amount to enter

Form 1040-C - U.s. Departing Alien Income Tax Return - 1998 Page 3

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