Publication 54 - Tax Guide For U.s. Citizens And Resident Aliens Abord - 2011 Page 25
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
442555
OMB No. 1545-0074
Foreign Earned Income
2011
Form
See separate instructions.
Attach to Form 1040.
Attachment
Department of the Treasury
▶
▶
34
Sequence No.
Internal Revenue Service
For Use by U.S. Citizens and Resident Aliens Only
Name shown on Form 1040
Your social security number
111-00-1111
James M. Adams
General Information
Part I
1
2
Your foreign address (including country)
Your occupation
10 North Avenue, City A, Country X
Engineer
Pan American Oil Company
3
Employer’s name
▶
N/A
4 a Employer’s U.S. address
▶
65 South Avenue, City A, Country X
b Employer’s foreign address
▶
X
a
A foreign entity
b
A U.S. company
c
Self
5
Employer is (check
any that apply):
d
A foreign af liate of a U.S. company
e
Other (specify)
▶
2010
6 a If, after 1981, you led Form 2555 or Form 2555-EZ, enter the last year you led the form.
▶
b If you did not le Form 2555 or 2555-EZ after 1981 to claim either of the exclusions, check here
and go to line 7.
▶
c Have you ever revoked either of the exclusions? .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Yes
No
d If you answered “Yes,” enter the type of exclusion and the tax year for which the revocation was effective.
▶
United States
7
Of what country are you a citizen/national?
▶
8 a Did you maintain a separate foreign residence for your family because of adverse living conditions at your
tax home? See Second foreign household in the instructions
Yes
No
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
b If “Yes,” enter city and country of the separate foreign residence. Also, enter the number of days during your tax year that you
City Y, Country Y 365 days
maintained a second household at that address.
▶
City A, Country X 6-9-2008
9
List your tax home(s) during your tax year and date(s) established.
▶
Next, complete either Part II or Part III. If an item does not apply, enter “NA.” If you do not give
the information asked for, any exclusion or deduction you claim may be disallowed.
Taxpayers Qualifying Under Bona Fide Residence Test (see instructions)
Part II
10
Date bona de residence began
, and ended
▶
▶
11
a
b
c
Kind of living quarters in foreign country
Purchased house
Rented house or apartment
Rented room
▶
d
Quarters furnished by employer
12a Did any of your family live with you abroad during any part of the tax year? .
Yes
No
.
.
.
.
.
.
.
.
.
.
b If “Yes,” who and for what period?
▶
13 a Have you submitted a statement to the authorities of the foreign country where you claim bona de
residence that you are not a resident of that country? See instructions
.
.
.
.
.
.
.
.
.
.
.
.
Yes
No
b Are you required to pay income tax to the country where you claim bona de residence? See instructions .
Yes
No
If you answered “Yes” to 13a and “No” to 13b, you do not qualify as a bona fide resident. Do not complete the rest of
this part.
If you were present in the United States or its possessions during the tax year, complete columns (a)–(d) below. Do not
14
include the income from column (d) in Part IV, but report it on Form 1040.
(c) Number of
(d) Income earned in
(c) Number of
(d) Income earned in
(a) Date
(b) Date left
(a) Date
(b) Date left
days in U.S.
U.S. on business
days in U.S. on
U.S. on business
arrived in U.S.
U.S.
arrived in U.S.
U.S.
on business
(attach computation)
business
(attach computation)
15a List any contractual terms or other conditions relating to the length of your employment abroad.
▶
b Enter the type of visa under which you entered the foreign country.
▶
c Did your visa limit the length of your stay or employment in a foreign country? If “Yes,” attach explanation .
Yes
No
d Did you maintain a home in the United States while living abroad? .
.
.
.
.
.
.
.
.
.
.
.
.
.
Yes
No
e If “Yes,” enter address of your home, whether it was rented, the names of the occupants, and their relationship
to you.
▶
2555
For Paperwork Reduction Act Notice, see the Form 1040 instructions.
Form
(2011)
Cat. No. 11900P
Chapter 4 Foreign Earned Income and Housing: Exclusion – Deduction
Page 25
ADVERTISEMENT
0 votes
Related Articles
Related forms
Publication 500 - Tax Guide For Wisconsin Political Organizations And Candidates - Department Of Revenue
Financial
Form Dhcs 0001 - California U.s. Citizens And Nationals Applying For Medi-cal Must Show Proof Of Citizenship And Identity (korean) - Health And Human Services Agency
Legal
Related Categories
Parent category: Financial