Form 1040nr-Ez - U.s. Income Tax Return For Certain Nonresident Aliens With No Dependents - 2013 Page 2

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2
Form 1040NR-EZ (2013)
Page
Schedule OI- Other Information (see instructions)
Answer all questions
A
Of what country or countries were you a citizen or national during the tax year?
In what country did you claim residence for tax purposes during the tax year?
B
C
Have you ever applied to be a green card holder (lawful permanent resident) of the United States? .
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Yes
No
D
Were you ever:
1.
A U.S. citizen? .
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Yes
No
2.
A green card holder (lawful permanent resident) of the United States?
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Yes
No
If you answer “Yes” to (1) or (2), see Pub. 519, chapter 4, for expatriation rules that may apply to you.
E
If you had a visa on the last day of the tax year, enter your visa type. If you did not have a visa, enter your U.S. immigration
status on the last day of the tax year.
F
Have you ever changed your visa type (nonimmigrant status) or U.S. immigration status? .
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Yes
No
If you answered “Yes,” indicate the date and nature of the change.
▶
G
List all dates you entered and left the United States during 2013 (see instructions).
Note. If you are a resident of Canada or Mexico AND commute to work in the United States at frequent
intervals, check the box for Canada or Mexico and skip to item H .
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Canada
Mexico
Date entered United States
Date departed United States
Date entered United States
Date departed United States
mm/dd/yy
mm/dd/yy
mm/dd/yy
mm/dd/yy
H
Give number of days (including vacation, nonworkdays, and partial days) you were present in the United States during:
2011
, 2012
, and 2013
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I
Did you file a U.S. income tax return for any prior year?
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Yes
No
If “Yes,” give the latest year and form number you filed
▶
J
Income Exempt from Tax—If you are claiming exemption from income tax under a U.S. income tax treaty with a foreign country,
complete (1) and (2) below. See Pub. 901 for more information on tax treaties.
1.
Enter the name of the country, the applicable tax treaty article, the number of months in prior years you claimed the
treaty benefit, and the amount of exempt income in the columns below. Attach Form 8833 if required (see instructions).
(b) Tax treaty
(d) Amount of exempt
(c) Number of months
(a) Country
article
claimed in prior tax years
income in current tax year
(e) Total. Enter this amount on Form 1040NR-EZ, line 6. Do not enter it on line 3 or line 5 .
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2.
Were you subject to tax in a foreign country on any of the income shown in 1(d) above?
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Yes
No
1040NR-EZ
Form
(2013)

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