Usa Income Tax Return

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USA INCOME TAX RETURN
APPLICATION FORM
PERSONAL INFORMATION
mm
dd
yyyy
Full name
Date of Birth
_____ / _____ / _________
Occupation
SSN/ITIN
-
-
Telephone
Mobile
Email
Address
Filing Status Preferences: Single
Married Filing Separately
Married Filing Joint*
Widow(er)
*If you decide to file a joint return with your spouse, combined world-wide income should be disclosed
SPOUSE INFORMATION
dd
yyyy
mm
Full name
Date of Birth
_____ / _____ / _________
Occupation
SSN/ITIN
-
-
CHILD AND DEPENDENT'S INFORMATION*
Number of
Full time
Relationship
months lived
Full name:
SSN/ITIN
Date of Birth:
student?
to you
with you during
the tax year
Yes
No
mm
dd
yyyy
-
-
___/___/______
Yes
No
mm
dd
yyyy
-
-
___/___/______
Yes
No
mm
dd
yyyy
-
-
___/___/______
Yes
No
mm
dd
yyyy
-
-
___/___/______
* If more than 4 dependents provide additional information on a separate sheet.
ADDITIONAL PERSONAL AND FILING INFORMATION
Can you be claimed as a dependent on another person’s tax return? Yes
No
Are you a full-time student? Yes
No
Are you blind or disabled? Yes
No
Did you file federal and state tax returns last year? Yes
No
Did you itemize deductions on your last year’s tax return? Yes
No
Do not know
Date you left the USA
____ / ____ / ________
Have you filed form 2555 or 2555-EZ in any prior year? Yes
No
Do not know
mm
dd
yyyy
Date you returned (or intend to return) to the USA permanently
____ / ____ / ________
If the return date is indefinite leave the field blank.
mm
dd
yyyy
Would you like to file (amend) a tax return for any other tax year(s)? Yes
No
If yes, give the tax year(s) here
________________________________________________________
, IDA Business & Technology Park, Ring Road, Kilkenny, Ireland

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