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Jim Ewing
284 Bartmess Blvd
Sparks, NV 89436-6037
Cell: 775-250-3743
Fax 775-425-0841e-Mail: JimEwing@Ewing-Enterprises.com
Note NEW Email address
Tax Preparation, PC Consultant,
PC Doctor, Website Webmaster
Website:
www.ewing-enterprises.com
Foreign Earned Income
Form 2555
Part I – General Information:
Your foreign address (including country): ____________________________________________
___________________________________________________________________________
Your Employers Name: ________________________________________________________
Your employers US address (if any): _________________________________________
_____________________________________________________________________
Name of your country of citizenship: ______________________________________________
Your “Tax Home” is the place(s) where you lived (not visited) all year. List the dates where you lived during this tax year, and the addresses of those places:
Dates: from: _____ to: _______ Address: _________________________________________
Dates: from: _____ to: _______ Address: _________________________________________
Dates: from: _____ to: _______ Address: _________________________________________
Part II – Taxpayers Qualifying under the Bona Fide Residence Tests:
If you are a legal resident (don’t confuse this with citizenship) of the foreign country, give the date the residence began: __________ Date ended: _____________ (enter “continue if it has not ended).
What kind of living quarters do you occupy: Purchased home ____ Rent: ____ Provided by employer: _____
Did any of your family live with you during the tax year (do not count visits) _____
If yes, who and how long? _________________________________________________
Have you submitted a statement to that country where you are living that you are NOT a resident of that country? ______
Are you required to pay income taxes to the country where you live? _____
Enter the type of Visa under which you entered the foreign country: ___________________
Did your Visa limit the length of your stay or employment in the foreign country? _________
If so please explain: _________________________________________________________
Did you maintain a home in the US while living abroad? __________________
If yes, enter the address of your home, whether rented or owned, names of occupants and their relationship to you: _________________________________________________
Part III -- Taxpayers qualifying under the physical presence test:
The physical presences test is based on the 12 month period from: date:________ through date: ____________
Enter your principal country of employment during your tax year: ___________________
If you traveled abroad during the tax year enter the dates/places where you stayed 24 hours or more:
Name of Country Date Arrived Date Departed Income earned
_________________ __________ ___________ ____________
_________________ __________ ___________ ____________
_________________ __________ ___________ ____________
_________________ __________ ___________ ____________
_________________ __________ ___________ ____________
Part IV All taxpayers:
Total Wages, Salares, Bonuses, Commissions etc: ____________
Non Cash income (value of items received that were furnished by employer:
Home (Lodging) _________
Meals _________
Car _________
Other: _________