OMB No. 1545-0067

Form 2555 Foreign Earned Income
® Attach to Form 1040. 1982

Department of the Treasury D> See separate instructions.
Internal_Revenue_ Service

For Use by United States Citizens and Resident Aliens Only
Name of taxpayer Social security number

Foreign address (including country) Your occupation

Name of employer >

Employer's US. &
address Foreign >

Employer is (check \ [A foreign entity Ty AUS. company

any that apply) [A foreign affiliate of a U.S. company CO seit [J Other (specity) >

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

Enter earlier years you filed Form 2555 >

Test under which you qualify to claim } (J Bona fide residence test. (Part I) Are you a

the exclusion(s) and/or deduction (J Physical presence test. (Part II) US. citizen? . . . [] Yes [] No

Did you maintain a separate foreign residence for your family because of adverse living conditions at your tax

home? 6 6 6 ee ee ee ee ee ee eee ee Yes [No
If “Yes,” give city and country of the separate foreign residence. Also show the number of days during your tax year that you main-
tained a second household at that address.

List your tax home(s) during your tax yea

Complete either Part | or Part Il. If an item does not apply, write “‘NA.” If you do not provide
the information asked for, any exclusion or deduction you claim may be disallowed.

Taxpayers Qualifying Under Bona Fide Residence Test (See instructions.)

1 List the countries where you lived and the dates of residence during your 1981 and 1982 tax years

, ended (date)_.

jona fide residence began (date) _. -
jouse or apartment C7 Rented room

2. Kind of living quarters in foreign country p> [] Purchased house
CO Quarters furnished by employer

3 Did any of your family live with you abroad during any part of the tax year?. . . 1 we we ee O Yes [] No

If “Yes,” who and for what period? P>__..

4a Have you submitted a statement to the authorities of the foreign country where you claim bona fide residence

that you are not a resident of that country? (See instructions). . 2... ee ee ee + + + [Yes [No

b Are you required to pay income tax to the country where you claim bona fide residence? (See instructions.) . +7 Yes [] No

If “Yes” to a and “No” to b, you do not qualify as a bona fide resident. Do not complete the rest of Part |.
5 Complete the following for days present in the U.S. or its possessions during the tax year (do not show this income in Part III,
but report it on Form 1040):

Number of Income earned in U.S. Number of | Income earned in US.
Date arrived Date tote days in U.S. ‘on business (Attach Date arrived Date teft days in U.S. ‘on business (Attach
in U.S. ‘on business computation.) ‘on business computation.)

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

b State the type of visa under which you entered the foreign country.
¢ Did your visa limit the length of your stay or employment in a foreign country?. . . 2. . 2 2 ee ee 7 Yes [] No

If “Yes,” attach explanation.
d_ Did you maintain a home in the U.S. while living abroad?. . . 6. + ee + ee ee ew ew ee Yes [No

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

For Paperwork Reduction Act Notice, see page 1 of separate instructions. 363-161-1


Form 2555 (1982)

Page 2

Part Il Taxpayers Qualifying Under Physical Presence Test (See instructions.)

7 The physical presence test is based on the 12-month period from . through __

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

9 Enter all travel abroad during the 12-month period shown on line 7, 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 the 12-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 12-month period. (Do not show the income in Part III

that you list here, but report it on Form 1040.)

Full days | Number of
Name of country Date arrived Date left

present in |days in U.S.
(ineluding U.S.) country | on business

Income earned in U.S.
on business. (Attach
computation.)

[eee All Taxpayers

Note: On lines 10 through 17 enter all income, including noncash income, that you earned and received during

1982 from sources out-

side the United States. If any of the foreign earned income received this tax year was earned in a prior tax year (such as a bonus),
see the instructions. Do not include income from Part |, line 5, or Part Il, line 9. Report amounts in U.S. dollars, using the ex-

change rates in effect when you actually or constructively received the income.
On Form 1040 report all income you received during 1982 no matter when you performed the service.

1982 Foreign Earned Income

Amount
(in U.S. dollars)

10 Total wages, salaries, bonuses, commissions, etc., earned. . 2. . ee ee ee
11 Allowable share of income for personal services performed (see instructions):
a Ina business (including farming) or profession. . 2 6 ee 8 ee ee ee ee ee

b Ina partnership (give name, address, and nature of income).

12 Noncash income (market value of property or facilities furnished by employer—attach statement showing
how determined):
a Home (lodging) © 6 6 6 we ee ee ee ee
b Meals. 2 6 ee ee ee
eCar .. a

14 Allowances, reimbursements, or expenses paid on your behalf for services you performed:
a Cost of living and overseas differential. . . . . . 1... . . « [da
b Family 6 6 6 ee ee ee ee ee [1M
c Education 6 6 ee ee ee ee we [abe
d Home leave. 2 6 ee ee ee 244)
e Quarters 2 6. ee ee ee ee fhe
f For any other purpose (specify)

g Add lines 14a through 14f © 6 6 1 ee wee ee ee ee ee ee
15 Add lines 10 through 13 and line 14g. . 6 6 ee we eee ee ee

16 Value of meals and lodging included on line 12 that are excludable. (See instructions.). . . . . -

12a
12b
12¢

Tl

17 Foreign earned income. (Subtract line 16 from line 15.). . . - - ee ee ee ee

17

Complete Part IV next if you choose to claim the housing exclusion or are claiming the housing deduction. Otherwise, skip to Part V.

363-161-1


Form 2555 (1982)

Page 3

[Zea For Taxpayers Claiming Housing Exclusion AND/OR Deduction

18 Qualified housing expenses for the tax year. (See instructions.). . . . . .
19 Number of days in your period of foreign residence or presence, whichever
applies, that fall within your 1982 tax year. . . eee ee. LAD
20 Multiply $17.40 by the number of days on line 19, but do not enter more than $6,350.00. . .
21 Subtract the amount on line 20 from the amount on line 18. (If zero or less, do not complete the rest of
Part IVoranyofPartVl.). 6. 6 6 6 6 ee ee ee ee ee
22 Enter employer-provided amounts. (See instructions.). . . . . . « «
23 Enter the amount from line 17... . ee
24

8

Divide the amount on line 22 by the amount on line 23 and enter the percentage here. (Limited to 100%.)

25 Housing exclusion. Multiply the amount on line 21 by the percentage on line 24, but do not enter more
than the amount on line 22. Also enter this amount on line 42, PartVIl. . . . se ee

\\E

e |g

8 all

Note: /f the amount on line 21 is more than the amount on line 25, complete line 26. Otherwise, skip to Part V if you choose to claim

the foreign earned income exclusion.

26 Subtract the amount on line 25 from the amount on line 21 and enter here and on line 35, Part VI. (Com-
plete Part V before Part VI, if you choose to claim the foreign earned income exclusion.) . ee

QTM For Taxpayers Claiming Foreign Earned Income Exclusion

27 Maximum foreign earned income exclusion. . . 6 6 6 6 8 8 ee ee ee ee 27 |
28 Number of days in your period of foreign residence or presence, whichever 7
applies, that fall within your 1982 taxyear. . . . . . . . LB UW,
29 Divide the number of days on line 28 by the number of days in your tax year (usually 365) and enter the
percentage here 2 6 1 we ee ee ee LBD
30 Multiply the amount on line 27 by the percentageonline29. . . 2... ew ee ee ee | 80
31 Enter the amount fromlinel7. . 2 ee ee ee ee ee LN 7
32 Enter the amount from line 25. . . . ree La
33 Subtract the amount on line 32 from the amount online31. 0. 6 6 6 ee ee ee ee ee | 88]
34 Foreign earned income exclusion. Enter here and on line 43, Part VII, the amount from line 30 or line 33,
whichever isless . . . + + . : eo ee IL

$75,000.00

%

For Taxpayers Claiming Housing Deduction

35 Enter the amount from line26. © © ee ee we ee ee

36 Enter the amount from line17. 2 6 6 1 ew ee ee ee
37 Enter the amount from line 25. 6. 6 6 we ee ee .
38 Enter the amount from line34. 0. 6 6 ee ee ee ee
39 Add the amounts on lines 37 and 38. 6 6 1 ee ee ee ee ee ee ee

40 Subtract the amount on line 39 from the amount on line36. . . « soe . . .

41 Enter the amount from line 35 or line 40, whichever is less. Also enter this amount on Form 1040 to the
left of line 31. Next to the amount write “Deduction from Form 2555.” Add it to the total adjustments
reported on that line... . . woe : . ree

w
©

i

41

For Taxpayers Claiming Housing Exclusion, Foreign E Earned Income Exclusion, or Both

42 Housing exclusion from line25. . . - ee ee eee [AZ
43 Foreign earned income exclusion from line a4. cee eee ee LB
44 Add the amounts on lines 42 and 43... 6 6 eee ee ee we ee ee ee
45 Deductions allocable to excluded income. (See instructions and attach computation.). . . . 2. « +

46 Subtract line 45 from line 44. Enter the result here and in parentheses on Form 1040, line 21. Next to the
amount write “Exclusion(s) from Form 2555." On Form 1040 subtract the amount from your income to
arrive at total income on Form 1040, line 22)... se ee

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U.S. GOVERNMENT PRINTING OFFICE ¢70—363-161

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