Form 1040-C

(Rev. January 2024)

Department of the Treasury 

Internal Revenue Service 

U.S. Departing Alien Income Tax Return

For tax period or year beginning , 20 , and ending , 20

Go to www.irs.gov/Form1040C for instructions and the latest information. 

File original and one copy.

OMB No. 1545-0074

Print 

or 

Type

Your first name and initial Last name Your social security number 

If a joint return, spouse’s first name and initial (see instructions) Last name Spouse’s identifying number

U.S. address (number, street, and apt. no. or rural route)

City, state, and ZIP code

Passport or alien registration card number

Your number Spouse’s number

Date on which you first arrived in the U.S.

Date of departure

Complete foreign address Date on which you last arrived in the U.S.

Of what country are you a citizen or national? Of what country are you a resident for tax purposes?

Caution: Form 1040-C is not a final income tax return. You must file a final return on the correct form after your tax year ends.

See Final Return Required in the instructions.

Part I Explanation of Status—Resident or Nonresident Alien—See instructions.

1 Check the box or boxes that apply. Note: A nonresident alien who has income from U.S. real property may elect to treat this

income as effectively connected income. Gain or loss on the disposition of a U.S. real property interest by a nonresident alien

is effectively connected income or loss. For details, see the Form 1040-NR instructions or Pub. 519, U.S. Tax Guide for Aliens.

Group I—Resident alien.

Group II—Nonresident alien with income effectively connected with a U.S. trade or business.

Group III—Nonresident alien with income not effectively connected with a U.S. trade or business.

2 Type of trade or business or occupation in the United States:

3 Visa number and class under which you were last admitted to the United States: 

4 Do you have a permit to reenter the United States? . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” enter the expiration date:

5 Have you signed a waiver of rights, privileges, exemptions, and immunities as described under Exceptions

in the instructions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” enter the date signed:

6 During your stay in the United States, did you furnish Form W-9, Request for Taxpayer Identification

Number and Certification, to a withholding agent? . . . . . . . . . . . . . . . . . . . Yes No

7 a Have you applied for U.S. citizenship? . . . . . . . . . . . . . . . . . . . . . . . Yes No

b Have you applied for, or taken other affirmative steps to apply for, lawful permanent resident status (green

card holder) in the United States, or do you have an application pending to change your status to that of a 

lawful permanent resident of the United States? . . . . . . . . . . . . . . . . . . . . Yes No

8 If you filed income tax returns in the United States, give the following information for the prior tax year.

a Type of return filed (for example, Form 1040, 1040-SR, 1040-NR, etc.):

b Your U.S. address, if any, shown on return:

c Taxable income reported $ d Total tax payments $ e Balance due $

9 Do you know of any current charges against you concerning your U.S. taxes for any tax period? . . . . Yes No

10 Do you plan to return to the United States? . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” complete lines 11 through 14 below.

11 Are your spouse and any children remaining in the United States? . . . . . . . . . . . . . . Yes No

12 Show the approximate value and location in the United States of any property held by you.

Value Location

a Real property { . . . . . . . . $ ;

. . . . . . . . $ ;

b Stocks and bonds . . . . . . . . $ ;

c Cash . . . . . . . . . . . . $ ;

d Other (specify): $ ;

13 At any time during the tax year, did you: (a) receive (as a reward, award, or payment for property or 

services); or (b) sell, exchange, or otherwise dispose of a digital asset (or a financial interest in a digital 

asset)? (See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

14 If you will not return to the United States before the due date for filing a final U.S. income tax return for the current year or the

due date for filing a final U.S. income tax return for the preceding year, what arrangements have you made to file the final 

income tax return(s) and pay the tax(es)? 

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see the instructions. Cat. No. 11310F Form 1040-C (Rev. 1-2024)
Form 1040-C (Rev. 1-2024) Page 2 

Part II Dependents—See instructions.

15

If more 

than four 

dependents,

see instructions.

(b) Social security 

number

(c) Relationship

to you

(d) ✔ if qualifies for (see instructions):

(a) First name Last name Child tax credit Credit for other dependents

Part III Figuring Your Income Tax

Groups 

I and II

16 Total income (from page 3, Schedule A, line 4, column (d) or (e)) . . . . . . . . . . . 16

17 Adjustments. See the instructions and attach appropriate form or statement . . . . . . . 17

18 Adjusted gross income. Subtract line 17 from line 16 . . . . . . . . . . . . . . . 18

19 Enter the amount from page 4, Schedule D, line 6 or 12, whichever applies . . . . . . . 19

20 Credits. See the instructions and attach appropriate form or statement . . . . . . . . . 20

21 Subtract line 20 from line 19. If zero or less, enter -0-. . . . . . . . . . . . . . . 21

22 Other taxes. See the instructions and attach appropriate form . . . . . . . . . . . . 22

23 Tax for Group I or II. Add lines 21 and 22 . . . . . . . . . . . . . . . . . . . 23

Group 

III

24 Total income (from page 3, Schedule A, line 4, column (f)) . . . . . . 24

25 Tax (multiply line 24 by 30% (0.30)). If less than 30% (0.30), attach statement showing computation. 

See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Tax 

Summary

26 Total tax. Add lines 23 and 25 . . . . . . . . . . . . . . . . . . . . . . 26

Note: Your tax liability on your final return may be different from line 26.

27 U.S. income tax paid or withheld at source (from page 3, Schedule A, lines 4

and 5, column (c)) . . . . . . . . . . . . . . . . . . . 27

28 Current year’s estimated tax payments and amount applied from preceding 

year’s tax return . . . . . . . . . . . . . . . . . . . . 28

29 Other payments (specify): 29

30 Total payments. Add lines 27 through 29 . . . . . . . . . . . . . . . . . . 30

31 If line 26 is more than line 29, subtract line 30 from line 26. This is the amount you owe . . . 31

32 If line 30 is more than line 26, subtract line 26 from line 30. This is the amount you overpaid. Any

overpayment of tax will be refunded only when you file your final return for the tax year . . . 32

Sign 

Here 

Joint return?

See instructions. 

Keep a copy 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, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Your signature Date Your occupation If the IRS sent you an Identity 

Protection PIN, enter it here 

(see inst.) 

Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation If the IRS sent your spouse an 

Identity Protection PIN, enter it here

(see inst.)

Phone no. Email address 

Paid 

Preparer 

Use Only

Print/Type preparer’s name Preparer’s signature Date Check if 

self-employed

PTIN

Firm’s name 

Firm’s address 

Firm’s EIN 

Phone no.

Certificate of Compliance

This certifies that the above individual(s) has satisfied all the requirements of the Internal Revenue Code and the Internal Revenue Regulations relating to departing aliens 

according to all information available to me at this date. This certificate is effective for the tax period

beginning , 20 , and ending , 20 , or the tax year ended , 20 .

(Field Assistance Area Director) 

Internal Revenue Service

Date , By

(Name) (Title)

Form 1040-C (Rev. 1-2024)
Form 1040-C (Rev. 1-2024) Page 3 

Schedule A Income—See instructions.

1 

(a) Payer of income

(b) Type of income 

(such as salary, wages, 

taxable interest, 

dividends, rents, etc.)

(c) Amount of U.S.

income tax paid or

withheld at source

(d) Resident alien 

income

Nonresident alien income

 (e) Effectively 

connected with a U.S.

trade or business

(f) Not effectively

connected with a U.S.

trade or business

2 Net gain, if any, from Schedule D (Form 

1040) . . . . . . . . . . . 2 

3 Net gain, if any, from Schedule B, line 2 3 

4 Totals . . . . . . . . . . . 4 

5 Exempt income. Do not include on line 4 5 

Schedule B Certain Gains and Losses From Sales or Exchanges by Nonresident Aliens of Property Not Effectively 

Connected With a U.S. Trade or Business—See instructions. Include any U.S. income tax that was paid or 

withheld on these sales or exchanges on Schedule A, line 3, column (c).

1 (a) Description of property 

(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) Gain or (loss) 

subtract (e) from (d)

2 Net gain. Combine the gains and losses entered on line 1, column (f). If the total is greater than zero, 

enter this net gain amount on Schedule A, line 3, column (f) . . . . . . . . . . . . . 2 

Schedule C Itemized Deductions—See instructions.

• If you are a resident alien reporting income on Schedule A, column (d), you may claim the same deductions allowable on 

Schedule A (Form1040).

• If you are a nonresident alien reporting income on Schedule A, column (e), you may claim only deductions that are connected to U.S. 

trade or business income and not deducted elsewhere. See Schedule A (Form 1040-NR). However, casualty or theft losses and 

charitable contributions do not have to be related to U.S. trade or business income. You should file Form 4684, Casualties and 

Thefts, to support casualty or theft losses shown below. See instructions for the extent to which casualty and theft losses are 

deductible.

• If you are a nonresident alien reporting income on Schedule A, column (f), do not claim any deductions related to that income.

1 (a) Type of deduction 

(such as interest, taxes, contributions, etc.)

(b) Amount 

of deduction

(c) Type of deduction 

(such as interest, taxes, contributions, etc.)

(d) Amount of 

deduction

2 Total itemized deductions. Add the amounts in columns (b) and (d) of line 1. Enter the total here

and on Schedule D, line 2 or line 8, whichever applies . . . . . . . . . . . . . . . 2 

Form 1040-C (Rev. 1-2024)
Form 1040-C (Rev. 1-2024) Page 4 

Schedule D Tax Computation—See instructions.

Tax for Resident Alien—Group I Only (For description of groups, see line 1 on page 1.)

1 Enter amount from page 2, line 18 . . . . . . . . . . . . . . . . . . . . . . . 1 

2 If you itemize deductions, enter amount from page 3, Schedule C, line 2. If you do not plan to itemize 

deductions, enter your standard deduction. See Standard Deduction (Group I only) in the instructions 2 

3 Taxable income. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . 3 

4 Tax. Figure your tax on the amount on line 3 by using the current year’s Tax Rate Schedules in the

instructions. Include in the total any tax from Form 4972 and Form 8814. Enter the tax here . . . . 4

5 Alternative minimum tax (AMT). Enter the amount, if any, of AMT from Form 6251 . . . . . . 5

6 Add lines 4 and 5. Enter the result here and on Form 1040-C, line 19 . . . . . . . . . . . 6

Tax for Nonresident Alien With Income Effectively Connected With a U.S. Trade or Business—Group II Only

7 Enter amount from page 2, line 18 . . . . . . . . . . . . . . . . . . . . . . . 7

8 Enter itemized deductions from page 3, Schedule C, line 2 . . . . . . . . . . . . . . 8

9 Taxable income. Subtract line 8 from line 7 . . . . . . . . . . . . . . . . . . . 9

10 Tax. Figure your tax on the amount on line 9 by using the current year’s Tax Rate Schedules in the

instructions. Include in the total any tax from Form 4972 and Form 8814. Enter the tax here . . . . 10

11 Alternative minimum tax (AMT). Enter the amount, if any, of AMT from Form 6251 . . . . . . 11

12 Add lines 10 and 11. Enter the result here and on Form 1040-C, line 19 . . . . . . . . . . 12

Form 1040-C (Rev. 1-2024)