IRS U.S. Nonresident Alien Income Tax Return
This is an IRS nonresident alien income tax return. The form provided here is a 2000 Form 1040NR and is simply a sample of what you will need to complete. Please be aware the tax returns differ every year.
U.S. Nonresident Alien Income Tax Return
Form 1040NR
For tax period or year beginning ___________, _______, and ending ______________, ________.
Department of the Treasury
Internal Revenue Service
OMB No. 1545-0089
Your first name and initial ________________________________
Last name __________________________
Your identifying number (see page 5 of Inst.) ________ ________ _________
Present home address (number, street, and apt. no. or rural route) If you have a P.O. box, see page 5. ___________________________
City, town or post office ________________________________
State ______________________________
ZIP code _____________________
If you have a foreign address, see page 5.
Check if: ___ Individual ___ Estate or Trust
Country ______________________
Of what country were you a citizen or national during the tax year? ____________________
Give address outside the United States to which you want any refund check mailed. If same as above, write "Same."____________________________
Give address in the country where you are a permanent resident. If same as above, write "Same."____________________________
Filing Status and Exemptions for Individuals (See page 6.)
Filing status. Check only one box (1-6 below).
1 Single resident of Canada or Mexico, or a single U.S. national 7a Yourself ________
2 Other single nonresident alien 7a Yourself ________
3 Married resident of Canada or Mexico, or a married U.S. national If you check box 7b, enter your spouse's identifying number____________________ ___ 7a Yourself ________, ___ 7b Spouse ________
4 Married resident of Japan or the Republic of Korea If you check box 7b, enter your spouse's identifying number ________________ ___ 7a Yourself ________, ___ 7b Spouse ________
5 Other married nonresident alien ___ 7a Yourself ________
6 Qualifying widow(er) with dependent child (year spouse died ________) (See page 6.) ___ 7a Yourself ________
Caution: Do not check box 7a if your parent (or someone else) can claim you as a dependent.
7c Dependents:
(1) First name ___________________________ Last name ___________________________
(2) Dependent's identifying number ___________________________
(3) Dependent's relationship to you ___________________________
(4) Check if qualifying child for child tax credit (see page 6) _______
(1) First name ___________________________ Last name ___________________________
(2) Dependent's identifying number ___________________________
(3) Dependent's relationship to you ___________________________
(4) Check if qualifying child for child tax credit (see page 6) _______
(1) First name ___________________________ Last name ___________________________
(2) Dependent's identifying number ___________________________
(3) Dependent's relationship to you ___________________________
(4) Check if qualifying child for child tax credit (see page 6) _______
No. of boxes checked on 7a and 7b . . . _______
No. of your children on 7c who:
*lived with you . . ________
**did not live with you due to divorce or separation . . _________
Dependents on 7c not entered above _______
*Applies generally only to residents of Canada, Mexico, Japan, and the Republic of Korea and to U.S. nationals. (See page 6.)
**Applies generally only to residents of Canada and Mexico and to U.S. nationals. (See page 6.)
d Total number of exemptions claimed, Add numbers entered on lines above ___________
Income Effectively Connected with Trade/Business
8 Wages, salaries, tips, etc. Attach Form(s) W-2 8 ______________
9a Taxable interest 9a __________________
b Tax-exempt interest. Do not include on line 9a 9b _________________
10 Ordinary dividends 10 __________________
11 Taxable refunds, credits, or offsets of state and local income taxes (see page 7) 11 _________________
12 Scholarship and fellowship grants. Attach explanation (see page 7) 12 ______________
13 Business income or (loss). Attach Schedule C or C-EZ (Form 1040) 13 ______________
14 Capital gain or (loss). Attach Schedule D (Form 1040) if required. If not required, check here 14 ____________
15 Other gains or (losses). Attach Form 4797 15 _______________
16a Total IRA distributions 16a _______________ 16b Taxable amount (see page 7) 16b _______________
17a Total pensions and annuities 17a ______________ 17b Taxable amount (see page 8) 17b _______________
18 Rental real estate, royalties, partnerships, trusts, etc. Attach Schedule E (Form 1040) 18 _______________
19 Farm income or (loss). Attach Schedule F (Form 1040) 19 _______________
20 Unemployment compensation 20 ________________
21 Other income. List type and amount (see page 9) _______________
22 Total income exempt by a treaty from page 5, Item M 22 __________________
23 Add lines 8, 9a, 10-15, 16b, and 17b-21. This is your total effectively connected income 23 _________________
Adjusted Gross Income
24 IRA deduction (see page 9) 24 _________________
25 Student loan interest deduction (see page 9) 25 _________________
26 Medical savings account deduction. Attach Form 8853 26 ________________
27Moving expenses. Attach Form 3903 27 ________________
28 Self-employed health insurance deduction (see page 10) 28 ________________
29 Self-employed SEP, SIMPLE, and qualified plans 29 _________________
30 Penalty on early withdrawal of savings 30 _________________
31 Scholarship and fellowship grants excluded 31 __________________
32 Add lines 24 through 31 32 _________________
33 Subtract line 32 from line 23. Enter here and on line 34. This is your adjusted gross income 33 _______________
Tax and Credits
34 Amount from line 33 (adjusted gross income) 34 _________________
35 Itemized deductions from page 3, Schedule A, line 17 35 ________________
36 Subtract line 35 from line 34 36 ________________
37 Excemptions (see page 11) 37 ________________
38 Taxable income. Subtract line 37 from line 36. If line 37 is more than line 36, enter -0- 38 ____________________
39 Tax (see page 11). Check if any tax is from a Form(s) a ___ Form(s) 8814, b ___ Form 4972 39 __________________
40 Alternative minimum tax. Attach Form 6251 40 ________________
41 Add lines 39 and 40 41 ________________
42 Foreign tax credit. Attach Form 1116 if required 42 _______________
43 Credit for child and dependent care expenses. Attach Form 2441 43 _______________
44 Child tax credit (see page 12) 44 ________________
45 Adoption credit. Attach Form 8839 45 ___________________
46 Other. Check if from a ___ Form 3800, b ___ Form 8396, c ___ Form 8801, d ___ Form (specify) 46 _______________
47 Add lines 42 through 46. These are your total credits 47 ____________________
48 Subtract line 47 from line 41. If line 47 is more than line 41, enter -0- 48 ________________
Other Taxes
49 Tax on income not effectively connected with a U.S. trade or business from page 4, line 83 49 ___________________
50 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 50 __________________
51 Tax on IRAs, other retirement plans, and MSAs. Attach Form 5329 if required 51 ________________
52 Transportation tax (see page 13) 52 _____________________
53 Household employment taxes. Attach Schedule H (Form 1040) 53 ___________________
54 Add lines 48 through 53. This is your total tax 54 ___________________
Payments
55 Federal income tax withheld from Forms W-2, 1099, 1042-S, etc. 55 __________________
56 2000 estimated tax payments and amount applied from 1999 return 56 ______________
57 Excess social security and RRTA tax withheld (see page 13) 57 _______________
58 Additional child tax credit. Attach Form 8812 58 _______________
59 Amount paid with Form 4868 (request for extension) 59 _________________
60 Other payments. Check if from a ___ Form 2439, b ___ Form 4136 60 ________________
61 Credit for amount paid with Form 1040-C 61 ________________
62 U.S. tax withheld at source:
a From page 4, line 80 62a ________________
b By partnerships under section 1446 (from Form(s) 8805 or 1042-S) 62b ________________
63 U.S. tax withheld on dispositions of U.S. real property interests:
a From Form(s) 8288-A 63a __________________
b From Form(s) 1042-S 63b __________________
64 Add lines 55 through 63b. These are your total payments 64 ____________________
Refund
65 If line 64 is more than line 54, subtract line 54 from line 64. This is the amount you overpaid 65 _________________
66a Amount of line 65 you want refunded to you. If you want it directly deposited, see page 14 and fill in 66b, c, and d 66a ___________________
b Routing number __________________ c Type: ___ Checking ___ Savings
d Account number __________________
67 Amount of line 65 you want applied to your 2001 estimated tax 67 __________________
Amount You Owe
68 If line 54 is more than line 64, subtract line 64 from line 54. This is the amount you owe.
For details on how to pay, including what to write on your payment, see page 14 68 _______________
69 Estimated tax penalty. Also include on line 68 69 _______________
Sign Here Keep a copy of this return for your records.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature _______________________________
Your occupation in the United States ______________________________
Date ________________________
May the IRS discuss this return with the preparer shown below (see page 17)? ___ Yes ___ No
Paid Preparer's Use Only
Preparer's signature _______________________________
Date ________________________ Check if self-employed ___
Preparer's SSN or PTIN ______________________________
Firm's name (or yours if self-employed) ___________________________________
Address _________________________________________
City ______________________________
State ____________________________
ZIP code ____________________
EIN ______________________________
Phone no. ____________________________
Schedule A--Itemized Deductions
State and Local Income Taxes
1 State income taxes 1 _________________
2 Local income taxes 2 _________________
3 Add lines 1 and 2 3 _________________
Gifts to U.S. Charities (Caution: If you made a gift and received a benefit in return, see page 15.)
4 Gifts by cash or check. If you made any gift of $250 or more, see page 15 4 _________________
5 Other than by cash or check. If you made any gift of $250 or more, see page 15. You must attach Form 8283 if "the amount of your deduction" (see definition on page 15) is more than $500 5 _________________
6 Carryover from prior year 6 _________________
7 Add lines 4 through 6 7 _________________
Casualty and Theft Losses
8 Casualty or theft loss(es). Attach Form 4684 8 _________________
Job Expenses and Most Other Miscellaneous Deductions
9 Unreimbursed employee expenses--job travel, union dues, job education, etc. You must attach Form 2106 or Form 2106-EZ if required. See page 15 ____________________ 9 _________________
10 Tax preparation fees 10 _________________
11 Other expenses. See page 16 for expenses to deduct here. List type and amount _____________________ 11 _________________
12 Add lines 9 through 11 12 _________________
13 Enter the amount from Form 1040NR, line 34 13 _________________
14 Multiply line 13 by 2% (.02) 14 _________________
15 Subtract line 14 from line 12. If line 14 is more than line 12, enter -0- 15 _________________
Other Miscellaneous Deductions
16 Other--certain expenses of disabled employees, estate tax on income of decedent, etc. List type and amount ________________________________ 16 _________________
Total Itemized Deductions
17 Is Form 1040NR, line 34, over $128,950 (over $64,475 if you checked filing status box 3, 4, or 5 on page 1 of Form 1040NR)?
No. Your deduction is not limited. Add the amounts in the far right column for lines 3 through 16. Also enter this amount on Form 1040NR, line 35.
Yes. Your deduction may be limited. See page 16 for the amount to enter here and on Form 1040NR, line 35.
17 _________________
Tax on Income Not Effectively Connected With a U.S. Trade or Business
Attach Forms 1042-S, SSA-1042S, RRB-1042S, 1001 or similar form.
Nature of income 70 Dividends paid by: a U.S. corporations
70a
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
b Foreign corporations 70b
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
71 Interest:
a Mortgage 71a
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
b Paid by foreign corporations 71b
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
c Other 71c
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
72 Industrial royalties (patents, trademarks, etc.) 72
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
73 Motion picture or T.V. copyright royalties 73
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
74 Other royalties (copyrights, recording, publishing, etc.) 74
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
75 Real property income and natural resources royalties 75
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
76 Pensions and annuities 76
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
77 Social security benefits 77
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
78 Gains (include capital gain from line 86 below) 78
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
79 Other (specify) _____________________________ 79
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
80 Total U.S. tax withheld at source. Add column (a) of lines 70a through 79. Enter the total here and on Form 1040NR, line 62a 80 (a) U.S. tax withheld at source __________________
81 Add lines 70a through 79 in columns (b)-(e) 81
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
82 Multiply line 81 by rate of tax at top of each column 82
(a) U.S. tax withheld at source __________________
Enter amount of income under the appropriate rate of tax (see pages 16 and 17)
(b) 10% __________________
(c) 15% __________________
(d) 30% __________________
(e) Other (specify) ____________% __________________
83 Tax on income not effectively connected with a U.S. trade or business. Add columns (b)-(e) of line 82. Enter the total here and on Form 1040NR, line 49 83 __________________
Capital Gains and Losses From Sales or Exchanges of Property
Enter only the capital gains and losses from property sales or exchanges that are from sources within the United States and not effectively connected with a U.S. business. Do not include a gain or loss on disposing of a U.S. real property interest; report these gains and losses on Schedule D (Form 1040).
Report property sales or exchanges that are effectively connected with a U.S. business on Schedule D (Form 1040), Form 4797, or both.
84 (a) Kind of property and description (if necessary, attach statement of descriptive details not shown below) _________________________________
(b) Date acquired (mo., day, yr.) _____________________________
(c) Date sold (mo., day, yr.) _____________________________
(d) Sales price _____________________________
(e) Cost or other basis _____________________________
(f) LOSS If (e) is more than (d), subtract (d) from (e) _____________________________
(g) GAIN If (d) is more than (e), subtract (e) from (d) _____________________________
85 Add columns (f) and (g) of line 84 85 (______________________)
86 Capital gain. Combine columns (f) and (g) of line 85. Enter the net gain here and on line 78 above (if a loss, enter -0-) 86 _____________________________
Other Information (If an item does not apply to you, enter "N/A.")
A What country issued your passport? __________________________
B Were you ever a U.S. citizen? ___ Yes ___ No
C Give the purpose of your visit to the United States _________________________________
D Type of entry visa and visa number _________________________________ and type of current visa and date of change _________________________________
E Date you first entered the United States _________________________________
F Did you give up your permanent residence as an immigrant in the United States this year? ___ Yes ___ No
G Dates you entered and left the United States during the year. Residents of Canada or Mexico entering and leaving the United States at frequent intervals, give name of country only. _________________________________
H Give number of days (including vacation and nonwork days) you were present in the United States during: 1998 ___________________, 1999 ___________________, and 2000 ___________________.
I If you are a resident of Canada, Mexico, Japan, or the Republic of Korea, or a U.S. national, did your spouse contribute to the support of any child claimed on Form 1040NR, line 7c? ___ Yes ___ No
If "Yes," enter amount $_____________________________
If you were a resident of Japan or the Republic of Korea for any part of the tax year, enter in the space below your total foreign source income not effectively connected with a U.S. trade or business. This information is needed so that the exemption for your spouse and dependents residing in the United States (if applicable) may be allowed in accordance with Article 4 of the income tax treaties between the United States and Japan or the United States and the Republic of Korea.
Total foreign source income not effectively connected with a U.S. trade or business $_________________________
J Did you file a U.S. income tax return for any year before 2000? ___ Yes ___ No
If "Yes," give the latest year and form number _________________________________
K To which Internal Revenue office did you pay any amounts claimed on Form 1040NR, lines 56, 59, and 61? _________________________________
L Have you excluded any gross income other than foreign source income not effectively connected with a U.S. trade or business? ___ Yes ___ No
If "Yes," show the amount, nature, and source of the excluded income. Also, give the reason it was excluded. (Do not include amounts shown in item M.) _________________________________
M If you are claiming the benefits of a U.S. income tax treaty with a foreign country, give the following information. See page 17 for additional information.
● Country _________________________________
● Type and amount of effectively connected income exempt from tax. Also, identify the applicable tax treaty article. Do not enter exempt income on lines 8-15, 16b, and 17b-21 of Form 1040NR:
For 2000 (also, include this exempt income on line 22 of Form 1040NR) _________________________________
For 1999 _________________________________
● Type and amount of income not effectively connected that is exempt from or subject to a reduced rate of tax. Also, identify the applicable tax treaty article:
For 2000 _________________________________
For 1999 _________________________________
● Were you subject to tax in that country on any of the income you claim is entitled to the treaty benefits? ___ Yes ___ No
● Did you have a permanent establishment or fixed base (as defined by the tax treaty) in the United States at any time during 2000? ___ Yes ___ No
N If you file this return to report community income, give your spouse's name, address, and identifying number. _________________________________
O If you file this return for a trust, does the trust have a U.S. business? ___ Yes ___ No
If "Yes," give name and address _________________________________
P Is this an "expatriation return" (see page 17)? ___ Yes ___ No
If "Yes," you must attach Form 8854 or attach an explanation as to why you are not submitting that form.
Q During 2000, did you apply for, or take other affirmative steps to apply for, lawful permanent resident status in the United States or have an application pending to adjust your status to that of a lawful permanent resident of the United States? ___ Yes ___ No
If "Yes," explain _________________________________