corm 23850 Application for Extension of Time

(Rev, Oct. 1973) for Filing U.S. Income Tax Return

Infernal Revenue Serica (For U.S. Citizens Abroad Who Expect to Qualify For Exempt Earned Income)
~~ File in duplicate on or before the due date for filing your return. See instructions on reverse.

Name of taxpayer(s) Your social security number
Please H i
Print Number and street, or rural route ‘Spouse's social security number
or
Type oo — : —

City or town, State, and ZIP code or country

1. An extension of time until .......... cesses eens coun. is hereby requested for filing the income tax return

for the year ended... _...... because | expect to qualify for exemption on my
income earned in foreign countries during such year for the reason stated below (Check one):
(a) [J] Bona fide residence in a foreign country or countries for uninterrupted period which includes an entire taxable year.

(b) [] Physical presence in a foreign country or countries for 510 full days of any 18-consecutive-month period.
2. Has an extension of time to file been previously granted for this taxable year?. . . . . . . . . « « » [] Yes [J] No

3. (a) Date of first arrival in foreign country -..........-
(b) Date qualifying period begins -
(c) Your address of residence in this foreign country
(d) Date of expected return to United States -.

. Last permanent address in United States -_.

. Office in which last return was filed (city and State)

. Occupation (if self-employed, describe fully) ....

. (a) Name and United States address of employer -...

Noage

CAUTIONARY NOT!

A. Election to have the Internal Revenue Service compute the income tax is not available to the taxpayer with, or without, an
extension if the return is filed later than the regular due date.

B. Interest accrues at the rate of 6% per year on any tax due from the regular due date of the return until paid. For the amount of pen-
alty due to late payment of tax, see instructions Requirements for filing.

Signature and Verification
If Prepared by Taxpayer
Under penalties of perjury, I declare that to the best of my knowledge and belief, the statements made herein are true and correct.

Signature of taxpayer ... _... Date

Spouse's signature ————----—-—---------ee ees ce coon eece eens cos Date

If Prepared by Someone Other Than Taxpayer
Under penalties of perjury, | declare that to the best of my knowledge and belief, the statements made herein are true,
correct, and complete, that | am authorized by the taxpayer to prepare this application, and that | am:

[5] A member in good standing of the bar of the highest court of (specify jurisdiction)

J A certified public accountant duly qualified to practice in (specify jurisdiction) __

[7] A person enrolled to practice before the Internal Revenue Service.

[7] A duly authorized agent holding a power of attorney. (The power of attorney need not be submitted unless r’ ~ vested.)

[5] A person standing in ciose personal or business relationship to the taxpayer who is unable to sign this applic. because of
illness, absence, or other good cause. My relationship to the taxpayer and the reasons why the taxpayer is unable to sign this appli-

cation are _

id return the original.

The Internal Revenue Service will indicate below whether the extension is granted o1 denied

Notice to Applicani-—-To Be Completed By the Internal Revenue Service
[Cj The application IS approved. (Please attach this form to the return.)

["] The application IS NOT approved.
Careful consideration has been given to the reasons stated in your application and it has been determined that the extension is
not warranted.

[1] The application cannot be considered since it was received in this office after the dus date of the retuin
( Other

Date



If the original copy of this application is to be returned to the taxpayer(s) at an address other than shown on page 1, or to an
agent acting for the taxpayer, please complete the section below: .

Name
Please | __ - - _
Print | Number and street
or
Type city or town, State and ZIP code 7 -

If possible, read Publication 54, Tax Guide for U.S. Citizens Abroad, before completing this application or filing your United States
income tax return. Copies may be obtained from offices of District Directors of Internal Revenue, from most United States embassies
and consulates, or by writing to the Internal Revenue Service Center, 11601 Roosevelt Boulevard, Philadelphia, Pennsylvania 19155,

U.S.A.

Requirements for filing.—A United States
citizen who received EARNED income for
personal services rendered by him in a for-
eign country or countries may obtain an
extension of time to file his United States
income tax return. An extension to 30 days
beyond the date upon which he can reason-
ably expect to qualify for the exemption
of such EARNED INCOME because he is
either a bona fide resident of a foreign
country or is physically present in the for-
eign country for an 18-month period may
be granted. An extension of time for filing
is a privilege which will not be granted if
your application is incomplete.

An extension of time to file a return, un-
less it specifies otherwise, does not extend
the time for payment of the tax. The law
imposes a penalty for the late payment of
tax (other than estimated tax) of one-half
percent per month or fractional part of a
month, unless you can show reasonable
cause for failure to pay on time. Interest
will accrue at the rate of 6 percent per year
on any tax due on the return from the
regular due date of the return until paid.

Where to file.—Complete in duplicate and
submit this application to either:

(1) The Internal Revenue Service
Center, 11601 Roosevelt Boule.
vard, Philadelphia, Pennsylvania
19155, or

(2) The local Revenue Service Repre-
sentative or other Revenue Serv-
ice Ernployee.

Definition of bona fide resident (Sec.
911(a)(2) of the Internal Revenue Code.)—
(a) General. A United States citizen who 1s
a bona fide resident of a foreign country
or countries for an uninterrupted period
which includes an entire taxable year may
consider as exempt certain amounts of
earned income derived from personal serv-
ices rendered abroad. For each of the first
three consecutive years of such bona fide
foreign residence, he may exclude no more
than $20,000 of earned income derived
during each such year. The maximum ex-
clusion for years of bona fide foreign resi-
dence following the first three consecutive
years is $25,000. There are certain condi-
tions under which earned income may not
be considered as exempt, regardless of the
bona fide foreign residence status of the

Instructions

taxpayer. Instructions under Special rules
applicable to bona fide residence and physi-
cal presence cover these restrictions.

(b) Determination of residence. No spe-
cific rule can be stated for determining
whether a United States citizen is a bona
fide resident of a foreign country, since
the determination involves his intentions
with respect to the length and nature of
his stay. The intention of the citizen to es-
tablish a bona fide residence in a foreign
country may be evidenced by words and
acts, but where they conflict, more empha
sis will be placed on the acts than on the
words. Generally, a citizen who goes to a
foreign country for a definite purpose,
which is of a temporary nature, and who
returns to the United States after the
purpose has been accomplished, 1s not
a bona fide resident of such foreign
country. However, if the purpose is of such
a nature that an extended and indefinite
stay may be necessary for its accomplish-
ment, and to that end the citizen makes
his home in the foreign country, he may be
a bona fide resident of such foreign coun-
try for Federal income tax purposes. The
term “foreign country’’ does not include a
possession of the United States.

(c) Statement of nonresidence. A citizen
who has made a statement to the authori-
ties of a foreign country in which he has
earned income that he is not a resident of
the country and has been held not subject
as a resident of that country to its income
tax is not to be treated as a bona fide resi-
dent of that foreign country. If a citizen
has made such a statement and, as of any
date a determination is being made as to
whether he qualifies as a bona fide foreign
resident, no adverse determination has
been made by the authorities of the for-
eign country with respect to his nonresi-
dence status, he shall be considered to
nave been held not subject to the income
tax of that foreign country.

Definition of those physically present in
foreign countries (Sec. 911(a)(2) of the
Internal Revenue Code).—(a) General. A
United States citizen who is physically
present in a foreign country or countries
for a total of at least 510 full days during
any period of 18 consecutive months may,
subject to the special rules set forth below,
exclude up to $20,000 of his earned in-
come for each taxable year if such earned

income is for services performed outside
the United States and is attributable to the
18-month period.

(b) Determination of 18-month period
and application of 510-day rule. In com-
puting the minimum of 510 full days
presence in any foreign country or coun-
tries, all separate periods of such presence
during the 18-month period are to be to-
taled. The 510 full days need not be con-
secutive, but may be interrupted by periods
during which the citizen is traveling over
international waters or 1s otherwise not
present in a foreign country.

Special rules applicable to bona fide resi-
dence and physical presence.—(a) Rule of
attribution. For purposes of determining
the exemption, earned income (whether re-
ceived before, during, or after the taxable
year in which the services to which the
amounts are attributable are performed) is
considered received in the taxable year in
which the services to which the amounts
are attributable are performed. This rule
applies only in determining the amount of
the exemption and does not affect the time
of reporting of any amounts which are not
exempt from tax. In no case shall amounts
be attributed to any year in which the serv-
ices performed are insubstantial in nature.

(b) Requirement as to time of receipt.
To be exempt, earned income must be re-
ceived before the ciose of the taxable year
following the taxable year in which the serv-
ices to which the amounts are attributable
are performed.

(c) Treatment of amounts paid by U.S.
Government, eic. Earned income paid by
the United States or any agency or instru-
mentality thereof is not exempt from tax
under the bona fide residence or physical
presence tests.

Request for any other reason.—if you re-
quest an extension for any reason other
than the fact that you expect to qualify
for exempt income earned abroad, submit
an application on Form 2688.

CAUTIONARY NOTE

The Internal Revenue Code provides for a
penalty for underpayment of estimated
tax. If you fail to qualify under either of
the definitions stated above for excluding
income from your return, you may be lia-
ble for this penalty. (See Publication 54.)

‘Ye US, GOVERNMENT PRINTING OFFICE ; 1973-O-500-129 -EI-62-0495459.