Irs Publication 54 - Tax Guide For U.s. Citizens And Resident Aliens Abroad - 2008 Page 25
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442555
OMB No. 1545-0074
Foreign Earned Income
Form
2008
See separate instructions.
Attach to Form 1040.
Attachment
Department of the Treasury
34
(99)
Sequence No.
Internal Revenue Service
For Use by U.S. Citizens and Resident Aliens Only
Name shown on Form 1040
Your social security number
James M. Adams
1 1 1 00
1 1 1 1
Part I
General Information
1
Your foreign address (including country)
2
Your occupation
Engineer
10 North Avenue, City A, Country X
Pan American Oil Company
3
Employer’s name
N/A
4a
Employer’s U.S. address
65 South Avenue, City A, Country X
b
Employer’s foreign address
X
5
Employer is (check
a
A foreign entity
b
A U.S. company
c
Self
any that apply):
d
A foreign affiliate of a U.S. company
e
Other (specify)
2007
6a
If, after 1981, you filed Form 2555 or Form 2555-EZ, enter the last year you filed the form.
b If you did not file 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.
7
Of what country are you a citizen/national?
United States
8a
Did you maintain a separate foreign residence for your family because of adverse living conditions at your
tax home? See Second foreign household on page 3 of 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
City Y, Country Y
366 days
you maintained a second household at that address.
City A, Country X
6-9-2002
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.
Part II
Taxpayers Qualifying Under Bona Fide Residence Test (see page 2 of the instructions)
10
Date bona fide residence began
, and ended
a
Purchased house
b
Rented house or apartment
c
11
Kind of living quarters in foreign country
Rented room
d
Quarters furnished by employer
Yes
No
12a
Did any of your family live with you abroad during any part of the tax year?
b
If “Yes,” who and for what period?
13a
Have you submitted a statement to the authorities of the foreign country where you claim bona fide residence
Yes
No
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 fide residence? See instructions
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.
14
If you were present in the United States or its possessions during the tax year, complete columns (a)–(d) below. Do not
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.
U.S. on business
arrived in U.S.
U.S.
arrived in U.S.
U.S.
on business
(attach computation)
on 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 page 4 of separate instructions.
Cat. No. 11900P
Form
(2008)
Chapter 4 Foreign Earned Income and Housing: Exclusion – Deduction
Page 25
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