Publication 54 - Tax Guide For U.s. Citizens And Resident Aliens Abroad - 2006 Page 28
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442555-EZ
OMB No. 1545-0074
Foreign Earned Income Exclusion
Form
2006
Department of the Treasury
Attachment
See separate instructions.
Attach to Form 1040.
34A
Internal Revenue Service
(99)
Sequence No.
Name shown on Form 1040
Your social security number
Judith E. Adams
222 00
2222
● Are a U.S. citizen or a resident alien.
● Do not have self-employment income.
● Earned wages/salaries in a foreign country.
You May Use
● Do not have business/moving expenses.
● Had total foreign earned income of
This Form
And You:
$82,400 or less.
● Do not claim the foreign housing
If You:
● Are filing a calendar year return that
exclusion or deduction.
covers a 12-month period.
Tests To See If You Can Take the Foreign Earned Income Exclusion
Part I
1
Bona Fide Residence Test
a
Were you a bona fide resident of a foreign country or countries for a period that includes an entire tax year
(see page 2 of the instructions)?
Yes
No
● If you answered “Yes,” you meet this test. Fill in line 1b and then go to line 3.
● If you answered “No,” you do not meet this test. Go to line 2 to see if you meet the Physical Presence Test.
b
Enter the date your bona fide residence began
, and ended (see instructions)
.
2
Physical Presence Test
a
Were you physically present in a foreign country or countries for at least 330 full days during—
2006 or
Yes
No
any other period of 12 months in a row starting or ending in 2006?
● If you answered “Yes,” you meet this test. Fill in line 2b and then go to line 3.
● If you answered “No,” you do not meet this test. You cannot take the exclusion unless you meet the
Bona Fide Residence Test above.
1-1-06
12-31-06
b
The physical presence test is based on the 12-month period from
through
.
3
Tax Home Test. Was your tax home in a foreign country or countries throughout your period of bona fide
residence or physical presence, whichever applies?
Yes
No
● If you answered “Yes,” you can take the exclusion. Complete Part II below and then go to page 2.
● If you answered “No,” you cannot take the exclusion. Do not file this form.
General Information
Part II
4
Your foreign address (including country)
5
Your occupation
21 Rue Reynaud
City Y, Country Y
Secretary
6
Employer’s name
7
Employer’s U.S. address (including ZIP code)
8
Employer’s foreign address
2645 Pewter Place
40 Rue Royale
A B Insurance Co., Inc.
Anytown, Anystate, U.S.A.
City Y, Country Y
9
Employer is (check any that apply):
a
A U.S. business
b
A foreign business
c
Other (specify)
2005
10a
If you filed Form 2555 or 2555-EZ after 1981, enter the last year you filed the form.
b
If you did not file Form 2555 or 2555-EZ after 1981, check here
and go to line 11a now.
c
Have you ever revoked the foreign earned income exclusion?
Yes
No
d
If you answered “Yes,” enter the tax year for which the revocation was effective.
City Y, Country Y 6-1-2000
11a List your tax home(s) during 2006 and date(s) established.
b Of what country are you a citizen/national?
United States
2555-EZ
For Paperwork Reduction Act Notice, see page 3 of separate instructions.
Cat. No. 13272W
Form
(2006)
Page 28
Chapter 4 Foreign Earned Income and Housing: Exclusion – Deduction
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