Form 2555 (1980)

Page 4

To Be Completed by Taxpayers Claiming the Exclusion of
Income Earned in a Hardship Area Camp OR the Exclusion of
Income Received for Qualified Charitable Services in a
Lesser Developed Country (See Instruction 19)

44 Complete the following for days you lived in a hardship area or lesser developed country durs
ing the tax year:

Full days you

. hardship ‘area
Name of hardship area i
or lesser developed country Date arrived Date departed

Number of days
during your
residence that
area qualified
as hardship area
or that you lived
ina lesser
developed country

45 Total number of full qualifying days in all hardship areas or lesser developed countries, (Enter here and on line
47 below.) . se

46 Maximum exclusion © 2 6 we ee ee

47 Number of days that you qualified for exclusion during the tax year (from line 45 above) .

48 Percentage applicable (divide the number of days on line 47 by 366). «© 2. 6 ee ee ee ee

49 Maximum allowable exclusion (multiply the amount on line 46 by the percent on line 48)... se.

$20,000.00

a

50 Enter the exclusion from line 49 or the amount you earned during the days you qualified, whichever is
smaller. 6 6 ee ee

51 Deductions allocable to excluded income. (See Instruction 19(c) and attach a schedule.) .

52 Subtract line 51 from line 50. Enter here and in parenthesis on Form 1040, line 21, and label it “Exclusion from
Form 2555". (On Form 1040, subtract the amount from your income to arrive at Total income on line 22.) . >

U.S. GOVERNMENT PRINTING OFFICE <70—313-161

¢70—313-161-2


Deduction from, or Exclusion of,
Income Earned Abroad 1980
36

rom 2000

Department of the Treasury
Internal Revenue Service

p> See separate instructions. b> Attach to Form 1040.
For the year January 1-December 31, 1980, or other tax year

beginning ... +1980, ending 19...... .
This Form Is To Be Used Only by United States Citizens and Resident Aliens
Name of taxpayer Social security number
Foreign address (including Country) Your occupation

Name_of employer >

Employer's US. >

address Foreign >

Employer is (check } LJ A foreign entity [] AUS. company [] A qualified charitable organization

any that apply) } (1 A foreign affiliate of a U.S. company CO Self (J _ Other (specify) >

Give the latest year for which you filed a U.S. income tax return D> Service Center where filed D>

Enter earlier years you claimed deduction from, or exclusion of, income earned abroad under section 911 or 913 >

Check the status under which you claim deduction from, } [1] Bona fide residence. Are you a

or exclusion of, income earned from services abroad § [| Physical presence. U.S. citizen? [] Yes [] No
Complete all items in either Part | or Part Il. If an item does not apply, write “DOES NOT APPLY.” Fail-
ure to submit required information may result in disallowance of the claimed deduction or exclusion.

To Be Completed for Bona Fide Residence Only (See Instruction 9)
1 List the countries where you have lived and the dates of residence during your 1979 and 1980 tax years...

Bona fide residence began (date) ended (date)
ign country P> [_] Purchased house [_] Rented house or apartment [7] Rented room [_] Quarters furnished by employer

3 Did any of your family live with you abroad during any part of the tax year?. . . . . . . . « « « + [] Yes [] No

If “Yes,” who and for what period? D>...
4 (a) Have you made a statement to the authorities of the foreign country you claim bona fide residence in that
you are not a resident of that country?. . . . se + es see + oe + + + [] Yes [No
(b) Are you required to pay income tax to the country you claim bona fide residence in?. . . . . . . « [J Yes [] No
If you made a statement to the authorities of the foreign country that you are not a resident, and the country

holds you are not subject to its income tax, you do not quality for this status. (See instruction 9(c).)
5 Complete the following for days present in the U.S. or its possessions during the tax year:

ji Date Number of Amount earned in U.S. on i Date Number of Amount earned in U.S. on
Date arrived departed days in U.S. | business (Attach statement Date arrived departed days in U.S. | business (Attach statement
in U.S. from U.S. on business showing computation.) * a from U.S. ‘on business ‘showing computation.) *

1 Do not include this income in Part Ill. Report on Form 1040.

6 (a) State any contractual terms or other conditions relating to the length of your employment abroad

(b) State the type of visa you entered the foreign country under _

(c) Did your visa contain any limitations as to the length of your
If “Yes,” attach explanation.

(d) Did you maintain a home in the U.S. while residing abroad?. . 6 6 1 ee ee ew ee ee ee PP Yes [J No

If “Yes,” show address of your home, whether it was rented, and the names and relationships of the occupants ..

META To Be Completed for Physical Presence Only (See Instruction 10)

7 The 18-month period that the test of physical presence in foreign countries is based on is from

8 Enter your principal country of employment during your tax year >...

9 Enter all travel abroad during the 18-month period that the test is based on, except travel between foreign countries that did not
involve travel on or over international waters for 24 hours or more. If the last entry is an arrival in a foreign country, enter the
number of full days to the end of 18-month period. If you have no travel to report during the period, write in the schedule that you
were physically present in a foreign country or countries during the entire 18-month period.

ig! untry?. . [] Yes [] No

.. through

Full days | Number of | Amount eared in U.S. on
tare ging US Date arrived Date departed present in | days inU.S. | business (Attach statement
g U.S. country | on business | __ showing computation.) *

Do not include this income in Part Ill. Report on Form 1040.

¢70—313-161-2


Form 2555 (1980) Page 2
[2am +To Be Completed by All Taxpayers

10 Enter on lines 11 through 18 all income, including noncash income, from sources outside the United States
earned during 1980. (See Instructions 7, 11(b), 11(c), and 11(d).) Is part of the income (such as bonuses) for
services performed in 1980, but received in another tax year?. . 2 1 1 6 we ew ee ee et Oo Yes [] No
If “Yes,” see Instructions 11(a) and 11(e).

Report all income received during 1980 on your Form 1040 regardless of when the services were performed, If you received
all or part of your income in foreign currency, translate its exchange value into terms of U.S. dollars at the rates prevailing
at the time you actually or constructively received the income. Do not report income shown in Part |, line 5, on this schedule.

Earned Income for Personal Services Rendered in Foreign Countries During 1980 Exchange, (tn Pets)

11 Total wages, salaries, bonuses, commissions, etc., earned this year. . . . . . - e
12 Pensions and annuities (see Instruction 11(d)) . . 2 1 6 ee ee ee ee

13 Alowabe share of income for personal services rendered this year (see Instructions 7 and Y/// V/V,

(a) In a business (including farming) or profession (attach Schedule C or F (Form 1040)) .
(b) In a partnership (give name, address, and nature of income) ..

14 Noncash remuneration (market value of property or facilities furnished by employer—attach Y j//,
statement showing how determined): YW

(a) Home (lodging). . . . . +
(b) Meals 2. 2 1 we we ee
(ce) Car 2 ww ee ee
(d) Other property or facilities (specify) ...

16 Allowances, reimbursements, or expenses paid on your behalf for services rendered this yes

N

(a) Cost of living. © 6 6 ee ee ee ee
(b) Overseas differential © 2 6 1 1 we ee ee ee ee ee
(c) Family 2 6 we ew eee ee ee ee
(d) Education © 6 6 6 ee ee ee ee ee
(e) Home leave © 6 ew ee

(f) Quarters . . 2. we
(g) For any other purpose (specify)

(h) Total allowances, reimbursements, etc. Add lines 16(a) through line 16(g). . . . .
17 Total earned income from foreign sources (add lines 11 through 15 and line 16(h)) . . .
18 (a) Value of meals and lodging included in income above which are excludable under section 1s. (Gee in.

struction 11(c)). 6 6 ee ee ee .
(b) Earned income from foreign sources (Subtract line 18(a) from line 17. Enter here and in Part wy,
line 42(a))_ . . . 1. ee

19 Did you maintain a separate foreign residence Tor your family due to adverse living conditions at your tax home? 0 Yes [J No

lf “Yes,” give city and country of the separate foreign residence. Also show number of days during your tax
year that you maintained a second household at that address

20 List your tax home(s) during your tax year,__ a
Did you change your tax home at any time during your tax year?. . 2 1 ww. we eee - + [J Yes [j No
Note: If you answered “Yes” to either 19 or 20 above, see Instructions 11, 15, and 17 before completing this form.

21 Did you live in a camp located in a hardship area for the convenience of your employer OR did you receive
income for qualified charitable services in a lesser developed country?. . . . 1... eee eee OD Yes [] No

(See Instruction 19 for a description of what is considered a camp and for a defi

charitable services in a lesser developed country.)

If “Yes,” you may elect (a) or (b) below. If “No,’”” you may claim (b) below.

(a) You may exclude from gross income the amount of $20,000 (prorated on a daily basis for days you lived
in a camp or a lesser developed country). See Part V.

(b)_You may claim the deduction for excess foreign living expenses. See Part IV.

ion of income for qualified

¢70—313-161-2


Form 2555 (1980)

Page 3

Etiam [0 Be Completed by Taxpayers Claiming the Deduction for Excess Foreign Living Expenses

Qualified Schooling Expense (See Instruction 13)

22 Complete the following for each dependent child for whom you claim a schooling expense deduction:

Name of dependent child Age Address (including country) of school attended

Schooling ex-
penses claimed

23 Total qualified schooling expenses. Enter here and on lines 31(b) and 36... a

Qualified Home Leave Transportation Expense (See instruction 14).

24 Enter total number of trips for which you are claiming a deduction. Count each trip by you, your spouse, and your
dependents as a separate trip > Total expense for all trips; also enter on lines 31(c) and 37. . >

Qualified Hardship Area Amount (See Instruction 15)

25 Name of hardship area .. Date tax home was established
26 Maximum amount. . . - eT
27 Number of days that you qualified during the stax year. . . .

28 Percentage applicable (divide the number of days on line 27 by 366). . . bee ee ee
29 Allowable amount (multiply the amount on line 26 by the percent on line 28). Also enter on lines 31d) and 38. re 2

ended

eee
$

Qualified Housing Expenses (See Instruction 17)

30 Expenses paid or incurred for housing at your tax home during the year. (If you maintained a qualified second

household, see Instruction 18 for additional information). . . . . 6. 1 ee we
31 Figure your base housing amount as follows. Enter:

(a) Housing income from all sources (see Instruction 17). . . . . . swe

(b) Qualified schooling expenses (from line 23) :

(c) Qualified home leave transportation expenses (from line 24).

(d) Qualified hardship area amount (from line 29) .

(e) Qualified cost-of-living differential (from tables—see Instruction 16)

(f) Housing expenses from line 30 . rn

(g) Total expenses (add lines 31(b) through 31h) . Se ee ee ee

(h) Subtract line 31(g) from line 31(a). . . . . So ee

(i) Base housing amount: Enter 20% (4) of line 31(h) - we ee ee ee ee
32 Subtract line 31(i) from line 30. If less than zero, enterzero. . . . eee
33 If you maintained a qualified second household, enter housing income as 5 modified by In-

struction 18(b)(i). Otherwise, omit line 33 and enter zero on line 34(e). . . . . .
34 Amount from line 31(g). .

(b) Add line 34 and line 34(a). 6 we we ee ee
(c) Subtract line 34(b) from line 33. If less than zero, enter zero. . . woe
(d) Base housing amount for second household; enter 20% (14) of line 34() . woe

(e) Subtract line 34(d) from line 34a). 6 6 6 ee ee ee eo et we ew

35 Total qualified housing expenses. If you maintained a qualified second household and your tax home was in a
hardship area, enter total of amounts on lines 30 and 34(e). Otherwise, enter the total of lines 32 and 34(e).
Also enter online40. 0... ee

‘Summary of Excess Foreign Living Expenses.

36 Qualified schooling expenses from line 23... 2 ee 8 8 8 ee ee ee ee ee
37 Qualified home leave transportation expenses from line24. 2. 1 6 6 ee ee ee ee et
38 Qualified hardship area amount from line 29. . 6 1 ee ee ee ee ee
39 Qualified cost-of-living differential from line 31(e). «6 ee ee ee ee ee ee ee
40 Qualified housing expenses from line 35... 1 we ke ee ee ee
41 Total expenses (add lines 36 through 40). 6 6 ww ee ee
42 Limitation:

(a) Earned income from foreign sources (from Part Ill, line 18(b)). . . . 6 . we

(b) Adjustments allocable to income from foreign sources (see Instruction 12(b)). . . «

(c) Net earned income from foreign sources (subtract line 42(b) from line 42(a)). If less

than zero, enter zero. 6 ee we ee ee
43 Deduction for excess foreign living expenses. Enter the amount from line 41 or 42(c), whichever i is smaller. Also
enter this amount on Form 1040, line 24, and label it as “Expense from Form 2555"... ss

¢70—313-161-2