Form 2555-EZ

Department of the Treasury 

Internal Revenue Service (99) 

Foreign Earned Income Exclusion 

▶ Attach to Form 1040. 

▶ Information about Form 2555-EZ and its separate instructions is at www.irs.gov/form2555. 

OMB No. 1545-0074 

2012

Attachment 

Sequence No. 34A 

Name shown on Form 1040 Your social security number 

You May Use 

This Form 

If You: 

• Are a U.S. citizen or a resident alien. 

• Earned wages/salaries in a foreign country. 

• Had total foreign earned income 

of $95,100 or less.

• Are filing a calendar year return that covers 

a 12-month period. 

And You: 

• Do not have self-employment income. 

• Do not have business/moving expenses. 

• Do not claim the foreign housing 

exclusion or deduction. 

Part I Tests To See If You Can Take the Foreign Earned Income Exclusion 

1 Bona Fide Residence Test 

a Were you a bona fide resident of a foreign country or countries for a period that includes an entire tax year 

(see page 2 of the instructions)? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

• If you answered “Yes,” you meet this test. Fill in line 1b and then go to line 3. 

• If you answered “No,” you do not meet this test. Go to line 2 to see if you meet the Physical Presence Test. 

b Enter the date your bona fide residence began ▶ , and ended (see instructions) ▶ . 

2 Physical Presence Test 

a Were you physically present in a foreign country or countries for at least 330 full days during— 

{ 2012 or

any other period of 12 months in a row starting or ending in 2012? } . . . . . . . . . . . . . Yes No

• If you answered “Yes,” you meet this test. Fill in line 2b and then go to line 3. 

• If you answered “No,” you do not meet this test. You cannot take the exclusion unless you meet the 

Bona Fide Residence Test above. 

b The physical presence test is based on the 12-month period from ▶ through ▶ . 

3 Tax Home Test. Was your tax home in a foreign country or countries throughout your period of bona fide 

residence or physical presence, whichever applies? . . . . . . . . . . . . . . . . . . . Yes No

• If you answered “Yes,” you can take the exclusion. Complete Part II below and then go to page 2. 

• If you answered “No,” you cannot take the exclusion. Do not file this form. 

Part II General Information 

4 Your foreign address (including country) 5 Your occupation 

6 Employer’s name 7 Employer’s U.S. address (including ZIP code) 8 Employer’s foreign address 

9 Employer is (check any that apply): 

a A U.S. business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b A foreign business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Other (specify) ▶

10 a If you previously filed Form 2555 or 2555-EZ, enter the last year you filed the form. ▶

b If you did not previously file Form 2555 or 2555-EZ, check here ▶ and go to line 11a now. 

c Have you ever revoked the foreign earned income exclusion? . . . . . . . . . . . . . . . Yes No

d If you answered “Yes,” enter the tax year for which the revocation was effective. ▶

11a List your tax home(s) during 2012 and date(s) established. ▶

b Of what country are you a citizen/national? ▶

For Paperwork Reduction Act Notice, see the Form 1040 instructions. Cat. No. 13272W Form 2555-EZ (2012) 
Form 2555-EZ (2012) Page 2 

Part III Days Present in the United States— Complete this part if you were in the

United States or its possessions during 2012. 

12 (a) Date arrived in U.S. (b) Date left U.S. (c) Number of days

in U.S. on business 

(d) Income earned in U.S.

on business (attach computation) 

Part IV Figure Your Foreign Earned Income Exclusion 

13 Maximum foreign earned income exclusion . . . . . . . . . . . . . . . . . . 13 

14 Enter the number of days in your qualifying period that fall within 2012 . 14 days 

15 Did you enter 366 on line 14? 

Yes. Enter “1.000.” 

No. Divide line 14 by 366 and enter the result as 

a decimal (rounded to at least three places). } . . . . . . . . . . . . . 15 × . 

16 Multiply line 13 by line 15 . . . . . . . . . . . . . . . . . . . . . . . . 16 

17 Enter, in U.S. dollars, the total foreign earned income you earned and received in 2012 (see 

instructions). Be sure to include this amount on Form 1040, line 7 . . . . . . . . . . . 17 

18 Foreign earned income exclusion. Enter the smaller of line 16 or line 17 here and in parentheses 

on Form 1040, line 21. Next to the amount enter “2555-EZ.” On Form 1040, subtract this amount 

from your income to arrive at total income on Form 1040, line 22 . . . . . . . . . . . ▶ 18 

Form 2555-EZ (2012)