rom O200 Exemption From Withholding on Compensation for

. OMB No. 1545-07
(Rev. December 1985) Independent Personal Services of a 0 1545-079
Department of the Treasury . . pan Expires 12-31-87
Internal Revenue Service Nonresident Alien Individual

This exemption is applicable for compensation for calendar year 19 ... . , or other tax year beginning ...............- ,19 ,

and ending .

ixlagy Nonresident Alien Individual

Name Taxpayer identification number

(see instructions)
United States visa number (if any)

‘Address (number and street)

City, state, and ZIP code

Citizens of Canada or Mexico complete either item 1 or item 2; all other filers complete item 1.| 2, Permanent address

1. a. Country issuing passport _
b. Passport number

3. Compensation for independent personal services
a. Description __

b. Amount (see instructions) $ -
c. If compensation is exempt from withholding because of a U.S. tax treaty, provide:
(1) Tax treaty and provision under which you are claiming exemption from withholding

(2) Your country of residence _

d. Is your compensation otherwise exempt (or will it be otherwise exempt) from income tax during the tax year? im Yes im No
(If you checked “Yes,” attach a statement explaining why.)
Additional facts to justify the exemption from withholding _

4. Number of personal exemptions you are claiming 5. Number of days independent personal services are to be
(see instructions) ________________-------------- performed in the United States during the tax year

Under penalties of perjury, | declare that | have examined this form and any accompanying statements, and to the best of my knowledge
and belief, they are true, correct, and complete. | also declare, under penalties of perjury, that | am not a citizen or resident of the United
States.

Signature of nonresident alien individual ® ______.______-_------------------------ DateR _______ ee
GEMM _ Withholding Agent Certification
Name Employer identification number

‘Address (number and street)

City, state, and ZIP code

Under penalties of perjury, | certify that | have examined this form and any accompanying statements, that | am satisfied that an
exemption from withholding is warranted, and that | do not know or have reason to know that the nonresident alien individual's
compensation is not entitled to the exemption or that the eligibility of the nonresident alien's compensation for the exemption cannot be
readily determined.

Signature of withholding agent > Date >

For Paperwork Reduction Act Notice, see back of form. Form 8233 (Rev. 12-85)


Form 8233 (Rev. 12-85)

Page 2

General Instructions

(All references are to the Internal Revenue
Code unless otherwise indicated.)

Paperwork Reduction Act Notice.—We ask
for this information to carry out the Internal
Revenue laws of the United States. We need it
to ensure that taxpayers are complying with
these laws and to allow us to figure and collect
the right amount of tax. If you want to receive
exemption from withholding on compensation
for independent personal services, you are
required to give us this information.

Purpose of Form.—In general, section 1441
requires that 30 percent of amounts paid toa
nonresident alien individual as compensation
for independent personal services (i.e., services
performed where there is no employer-
employee relationship) be withheld by the
person paying the amount (the withholding
agent) to the individual. This form is used by
nonresident alien individuals to claim
‘exemption from withholding on compensation
for independent personal services (under
section 1441 and its regulations), if the
exemption is based on a tax treaty to which the
United States is a party (a “U.S. tax treaty”), or
‘on the personal exemption amount. The form is
completed by the nonresident alien individual
claiming exemption and presented to the
withholding agent for review. If the withholding
agent accepts Form 8233, the withholding
agent so certifies on the same form and
forwards it to the Director, Foreign Operations
District at the address shown on this page. An
accepted Form 8233 is effective only for the tax
year shown on the form. Do not use Form
8233 if you have an office in the United States
regularly available to you for performing
personal services. If you have an office in the
United States regularly available to you, contact
the Director, Foreign Operations District, for
more information.

Definitions

Nonresident Alien Individual.—Any
individual who is not a resident or citizen of
the United States is a nonresident alien
individual. The term also includes a
nonresident alien fiduciary. An alien
individual meeting either the “green card
test” or the “substantial presence test" for the
calendar year is a resident. Those not meeting
either test are nonresident alien individuals.
Note: Nonresident alien individuals married
to U.S. citizens or resident aliens may choose
to be treated as resident aliens for income tax
purposes (e.g., for purposes of filing a joint
income tax return). However, these
individuals are considered nonresidents for
purposes of withholding taxes on nonresident
aliens. For further information on resident
and nonresident alien status, the tests for
residence, and the exceptions to them, see
Publication 519, U.S. Tax Guide for Aliens,
available at most IRS offices.

Nonresident Alien Fiduciary.—A
nonresident alien fiduciary is a nonresident
alien guardian, trustee, executor,
administrator, receiver, conservator, or other
person acting in any fiduciary capacity for any
person. However, a nonresident alien
fiduciary is not a nominee.

Compensation for Independent Personal
Services.—Independent personal services
are personal services performed in the United
States by an independent nonresident alien
contractor, rather than by a nonresident alien
employee. Included in compensation are
payments for professional services, such as

fees of an attorney, physician, or accountant
made directly to the person performing the
services, consulting fees, and payments for
performances by public entertainers, such as
artists, actors, musicians, and athletes. For
further information, see Publication 515,
Withholding of Tax on Nonresident Aliens and
Foreign Corporations, available at most IRS
offices.

Withholding Agent.—Any person required to
withhold tax on payments made toa
nonresident alien individual is a withholding
agent. Generally, the person who pays or
conveys the item of U.S. source income to the
nonresident alien individual (or to his or her
agent) is liable for the tax and must withhold.
The withholding agent may be an individual,
corporation, partnership, trust, association, or
any other entity. For further information, see
Publication 515.

Specific Instructions
Part!

Taxpayer identification number.—
Nonresident alien individuals (other than
nonresident alien fiduciaries) must enter their
social security number. If you have applied for
‘one but have not yet received it, enter
“Applied For” and the date you applied in the
space provided. If you do not have a social
security number, apply for one using Form
SS-5, Application for a Social Security Number
Card, and enter “Applied For” and the date
you applied in the space provided. When the
number is received, promptly give it to the
withholding agent. if you are a nonresident
alien fiduciary, enter your employer
identification number.

Items 1 and 2.—All filers must complete item
1, except for citizens of Canada or Mexico,
who can complete either item 1 or item 2.

Item 3a.—Describe the independent personal
services for which the compensation is being
(or will be) received, and describe the manner
of compensation (e.g., lump sum, monthly
payments, etc.).

Item 3b.—Enter the amount of compensation
for independent personal services you will be
receiving during the tax year to which this
Form 8233 applies. Enter an estimated
amount if the exact amount is not known.

Item 3d.—If the exemption from income tax
withholding is (or will be) based on other than
aU.S. tax treaty (e.g., the personal exemption
amount), explain this in an attached
statement.

Item 4.—For determining the amount of
compensation exempt from 30% withholding
because of the personal exemption amount,
one personal exemption is allowed a
nonresident alien individual who is nota
resident of Canada or Mexico, or is not a U.S.
national during the tax year. However, a
nonresident alien individual covered by a U.S.
tax treaty with his or her country may be
entitled to exemptions for a spouse and
dependents under certain circumstances. See
the applicable tax treaty for further
information. A nonresident alien individual who
is a resident of Canada or Mexico, or is a U.S.
national is generally allowed the same personal
exemptions as a U.S. citizen or resident. (For
further information, see Publication 519.)
Each allowable exemption must be prorated
according to the number of days the personal
services are performed in the United States
(see item 5). If the nonresident alien

individual's tax year begins in 1985, the
proration amount is $2.85 a day; if it begins in
1986, the amount is $2.96 a day.
Signature.—The nonresident alien individual,
or his or her legally authorized representative,
must sign and date Form 8233 in the
appropriate place

Part Il

Withholding Agent's Responsibilities
Regarding Form 8233.—When you are
presented Form 8233 by the nonresident alien
individual, review it to see if you are satisfied
that the exemption from withholding is
warranted, If, based on the facts presented,
you are so satisfied, accept Form 8233 by
makinga certification, under penalties of
perjury:

@ That you have examined Form 8233 and
any accompanying statements;

@ That you are satisfied that an exemption
from withholding is warranted; and

@ That you do not know or have reason to
know that the nonresident alien individual's
compensation is not entitled to exemption or
that the eligibility of the nonresident alien
individual's compensation for the exemption
cannot be readily determined.

Forward Form 8233 within 5 days of your
acceptance to:

Director, Foreign Operations District

Internal Revenue Service

1325 K Street, N.W.

Washington, DC 20225

Attn: FOD:51

Give the nonresident alien individual a copy
of Form 8233, and attach a copy of Form
8233 to the Form 1042S you file with IRS for
the nonresident alien individual. Keep a copy
of Form 8233 for your records.

The exemption from withholding becomes
effective for payments made at least 10 days
after you have mailed Form 8233 to the IRS.
(See the instructions for Part |, item 4, for
information on amounts exempt from
withholding because of the personal
exemption amount.)

You must not accept Form 8233 if either of
the following apply:

@ [Ifyou know or have reason to know that
any of the facts or assertions on Form 8233
may be false; or

@ You know or have reason to know that the
eligibility of the nonresident alien individual's
compensation for the exemption cannot be
readily determined (e.g., if you know or have
reason to know that a nonresident alien
individual has an office in the United States
regularly available for performing personal
services).

If you accept Form 8233 and subsequently
find that either of the situations described
immediately above apply, you must promptly
notify the Director, Foreign Operations
District, in writing and you must withhold on
any amounts not yet paid. If you are notified
by the Foreign Operations District that the
eligibility of the nonresident alien individual's
compensation for the exemption is in doubt or
that the compensation is ineligible for the
exemption, you must withhold. See
Regulations section 1.1441-4(b)(2)(iii) for
examples illustrating these rules.
Signature.—The withholding agent, or a duly
authorized agent of the withholding agent,
must sign and date Form 8233 in the
appropriate place. (See Regulations section
1.1441-7(b) for further information regarding
duly authorized agents.)