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Form 2555, Foreign Earned Income

This is a foreign earned income. The form provided here is simply a sample of what the actual Form 2555 looks like.

Form 2555
OMB No. 1545-0067

Department of the Treasury
Internal Revenue Service

Form Foreign Earned Income

For Use by U.S. Citizens and Resident Aliens Only

Name shown on Form 1040 ________________________

Your social security number ________________________

Part I General Information

1 Your foreign address (including country) ________________________

________________________

________________________

2 Your occupation ________________________

3 Employer's name ________________________

4a Employer's U.S. address ________________________

________________________

________________________

4b Employer's foreign address ________________________

________________________

________________________

5 Employer is (check any that apply):

a ____ A foreign entity

b ____ A U.S. company

c ____ Self

d ____ A foreign affiliate of a U.S. company

e ____ Other (specify) ________________________

6a If, after 1981, you filed Form 2555 to claim either of the exclusions or Form 2555-EZ to claim the foreign earned income exclusion, 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 now.

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? ________________________

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 you maintained a second household at that address. ________________________

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 ________________________

11 Kind of living quarters in foreign country

a ____ Purchased house

b ____ Rented house or apartment

c ____ 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?

13a Have you submitted a statement to the authorities of the foreign country where you claim bona fide 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 fide 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.

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.

(a) Date arrived in U.S. ________________________

(b) Date left U.S. ________________________

(c) Number of days in U.S. on business ________________________

(d) Income earned in U.S. on business (attach computation) ________________________


(a) Date arrived in U.S. ________________________

(b) Date left U.S. ________________________

(c) Number of days in U.S. on business ________________________

(d) Income earned in U.S. 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. ________________________

Part III Taxpayers Qualifying Under Physical Presence Test (See page 2 of the instructions.)

16 The physical presence test is based on the 12-month period from ________________________ through ________________________

17 Enter your principal country of employment during your tax year. ________________________

18 If you traveled abroad during the 12-month period entered on line 16, complete columns (a)-(f) below. Exclude travel between foreign countries that did not involve travel on or over international waters, or in or over the United States, for 24 hours or more. If you have no travel to report during the period, enter "Physically present in a foreign country or countries for the entire 12-month period." Do not include the income from column (f) below in Part IV, but report it on Form 1040.

(a) Name of country (including U.S.) ________________________

(b) Date arrived ________________________

(c) Date left ________________________

(d) Full days present in country ________________________

(e) Number of days in U.S. on business ________________________

(f) Income earned in U.S. on business (attach computation) ________________________


(a) Name of country (including U.S.) ________________________

(b) Date arrived ________________________

(c) Date left ________________________

(d) Full days present in country ________________________

(e) Number of days in U.S. on business ________________________

(f) Income earned in U.S. on business (attach computation) ________________________

Part IV All Taxpayers

Note: Enter on lines 19 through 23 all income, including noncash income, you earned and actually or constructively received during your 2000 tax year for services you performed in a foreign country. If any of the foreign earned income received this tax year was earned in a prior tax year, or will be earned in a later tax year (such as a bonus), see the instructions. Do not include income from line 14, column (d), or line 18, column (f). Report amounts in U.S. dollars, using the exchange rates in effect when you actually or constructively received the income.

If you are a cash basis taxpayer, report on Form 1040 all income you received in 2000, no matter when you performed the service.

2000 Foreign Earned Income

19 Total wages, salaries, bonuses, commissions, etc. 19 Amount (in U.S. dollars) ________________________

20 Allowable share of income for personal services performed (see instructions):

a In a business (including farming) or profession 20a Amount (in U.S. dollars) ________________________

b In a partnership. List partnership's name and address and type of income. 20b Amount (in U.S. dollars) ________________________

21 Noncash income (market value of property or facilities furnished by employer--attach statement showing how it was determined):

a Home (lodging) 21a Amount (in U.S. dollars) ________________________

b Meals 21b Amount (in U.S. dollars) ________________________

c Car 21c Amount (in U.S. dollars) ________________________

d Other property or facilities. List type and amount. 21d Amount (in U.S. dollars) ________________________

22 Allowances, reimbursements, or expenses paid on your behalf for services you performed:

a Cost of living and overseas differential 22a ________________________

b Family 22b ________________________

c Education 22c ________________________

d Home leave 22d ________________________

e Quarters 22e ________________________

f For any other purpose. List type and amount.
22f ________________________

g Add lines 22a through 22f 22g Amount (in U.S. dollars) ________________________

23 Other foreign earned income. List type and amount. 23 Amount (in U.S. dollars) ________________________

24 Add lines 19 through 21d, line 22g, and line 23 24 Amount (in U.S. dollars) ________________________

25 Total amount of meals and lodging included on line 24 that is excludable (see instructions) 25 Amount (in U.S. dollars) ________________________

26 Subtract line 25 from line 24. Enter the result here and on line 27 on page 3. This is your 2000 foreign earned income 26 Amount (in U.S. dollars) ________________________

Part V All Taxpayers

27 Enter the amount from line 26 27 ________________________

Are you claiming the housing exclusion or housing deduction?

____ Yes. Complete Part VI.

____ No. Go to Part VII.


Part VI Taxpayers Claiming the Housing Exclusion and/or Deduction

28 Qualified housing expenses for the tax year (see instructions) 28 ________________________

29 Number of days in your qualifying period that fall within your 2000 tax year (see instructions) 29 ________________________ days

30 Multiply $27.79 by the number of days on line 29. If 366 is entered on line 29, enter $10,171.00 here 30 ________________________

31 Subtract line 30 from line 28. If the result is zero or less, do not complete the rest of this part or any of Part IX 31 ________________________

32 Enter employer-provided amounts (see instructions) 32 ________________________

33 Divide line 32 by line 27. Enter the result as a decimal (rounded to at least three places), but do not enter more than "1.000" 33 ________________________

34 Housing exclusion. Multiply line 31 by line 33. Enter the result but do not enter more than the amount on line 32. Also, complete Part VIII 34 ________________________

Note: The housing deduction is figured in Part IX. If you choose to claim the foreign earned income exclusion, complete Parts VII and VIII before Part IX.

Part VII Taxpayers Claiming the Foreign Earned Income Exclusion

35 Maximum foreign earned income exclusion 35 $76,000.00

36 ● If you completed Part VI, enter the number from line 29.
● All others, enter the number of days in your qualifying period that fall within your 2000 tax year (see the instructions for line 29).
36 ________________________ days

37 ● If line 36 and the number of days in your 2000 tax year (usually 366) are the same, enter "1.000."
● Otherwise, divide line 36 by the number of days in your 2000 tax year and enter the result as a decimal (rounded to at least three places).
37 ________________________

38 Multiply line 35 by line 37 38 ________________________

39 Subtract line 34 from line 27 39 ________________________

40 Foreign earned income exclusion. Enter the smaller of line 38 or line 39. Also, complete 40 ________________________

Part VIII Taxpayers Claiming the Housing Exclusion, Foreign Earned Income Exclusion, or Both

41 Add lines 34 and 40 41 ________________________

42 Deductions allowed in figuring your adjusted gross income (Form 1040, line 33) that are allocable to the excluded income. See instructions and attach computation 42 ________________________

43 Subtract line 42 from line 41. Enter the result here and in parentheses on Form 1040, line 21. Next to the amount enter "Form 2555." On Form 1040, subtract this amount from your income to arrive at total income on Form 1040, line 22 43 ________________________

Part IX Taxpayers Claiming the Housing Deduction--Complete this part only if (a) line 31 is more than line 34 and (b) line 27 is more than line 41.

44 Subtract line 34 from line 31 44 ________________________

45 Subtract line 41 from line 27 45 ________________________

46 Enter the smaller of line 44 or line 45 46 ________________________

Note: If line 45 is more than line 46 and you could not deduct all of your 1999 housing deduction because of the 1999 limit, use the worksheet on page 4 of the instructions to figure the amount to enter on line 47. Otherwise, go to line 48.

47 Housing deduction carryover from 1999 (from worksheet on page 4 of the instructions) 47 ________________________

48 Housing deduction. Add lines 46 and 47. Enter the total here and on Form 1040 to the left of line 32. Next to the amount on Form 1040, enter "Form 2555." Add it to the total adjustments reported on that line 48 ________________________

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