2 3 5 0 Application for Extension of Time OMB No. 1545-0070
Form To File U.S. Income Tax Return 1990

pebartiment of the Treasury (For U.S. Citizens and Resident Aliens Abroad Who Expect To Qualify for Special Tax Treatment) Atachment 58

] Your first name and initial Last name’ Your social security number

Please type or | :
print. | Ifa joint return, spouse's first name and initial Last name ‘Spouse's social security number

File the original

and one copy by “| Bresent home address (number, street, and apt. no,, or rural route). (If you have a P.O, box, see the instructions.)
the due date for

filing your
return. City or town, province or state, foreign postal or ZIP code, and country

1 | request an extension of time until to file my income tax return
for the calendar year 1990, or other tax year ending _ because my tax
home is in a foreign country and | expect to qualify for special tax treatment by meeting the test I have checked below:

a Bona fide residence test (see instructions). . . . .»{[)_ b Physical presence test (see instructions) . . . . .e»O
2 Were you previously granted an extension of time to file for this tax year?. 2... coe eee ee ee es D1 Yes O No
3 Will you need additional time to allocate moving expenses? . . . . . . . Foe ee eee ee ee. OYes No
4a Date you first arrived in foreign country ___...__.-._.----------- en nnn eee eee

b Date qualifying period begins -
¢ Your foreign home address _
d Date you expect to return to the United States
Note: This is not an extension of time for payment of tax. Full pa yment is required to avoid interest and late payment charges.
5 _Enter the amount of income tax paid with this form... rr oe | |

Complete line 6 (and 7a or 7b if applicable) only if you expect to owe itt or generation }-skipping transfer (GST) tax. Do not include
income tax on these lines. (See the instructions.)

6 If you or your spouse expect to file a gift tax return (Form 7 709 or 709- 9-A) fo for 1990, 0, generally c due eby Apri 3} Yourself . . . >O
15, 1991, see the instructions and check here . Spouse .. . P[
7a

7a Enter the amount of gift or GST tax that you are paying with this form . rn
b Enter the amount of gift or GST tax that your spouse is paying with thisform 5... wl, _. | 7b
Signature and Verification

Under penalties of perjury, | declare that | have examined this form, including accompanying schedules and statements, and to the best of
my knowledge and belief, it is true, correct, and complete; and, if prepared by someone other than the taxpayer, that | am authorized to
prepare this form.

Signature of taxpayer > Date >
Signature of spouse Date >
Signature of preparer

other than taxpayer > Date >

File original and one copy. IRS will show below whether or not your application is approved and will return the copy.

Notice to Applicant—To Be Completed by IRS
We HAVE approved your application. (Please attach this form to your return.)

We HAVE NOT approved your application. (Please attach this form to your return.) However, after considering the above information,
we have granted a 45-day grace period from the date shown below or due date of your return, whichever is later. This grace period is
considered to be a valid extension of time for elections otherwise required to be made on returns filed on time.

(1 We HAVE NOT approved your application. After considering the above information, we cannot grant your request for an extension of
time to file. (We are not granting the 45-day grace period.)

O We cannot consider your application because it was filed after the due date of your return.
ce
By:
Date Director

If the copy of this form is to be returned to you at an address other than that shown above, or to an agent acting for you, please enter the
name of the agent and/or the address where the copy should be sent.

Name
Please
‘Type _| Number and street or P.O. box number (if mail is not delivered to street address)
or
Print

City or town, state, and ZIP code

For Paperwork Reduction Act Notice, see back of form. Form 2350 (1990)