OMB No. 1545-0067

Form 2555 Foreign Earned Income

Department of the Treasury

Internal Revenue Service

© See separate instructions. © Attach to Form 1040.

For Use by U.S. Citizens and Resident Aliens Only

Name shown on Form 1040 Your social security number

Your foreign address (including country) Your occupation

Employer’s name ©

Employer’s U.S. address ©

Employer’s foreign address ©

Employer is (check

any that apply):

A foreign entity A U.S. company

Other (specify) ©

Self

A foreign affiliate of a U.S. company

If, after 1981, you filed Form 2555 to claim either of the exclusions or Form 2555-EZ to claim the foreign earned income

exclusion, enter the last year you filed the form. ©

Have you ever revoked either of the exclusions? Yes No

If you answered “Yes,” enter the type of exclusion and the tax year for which the revocation was effective. ©

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

tax home? See Second foreign household on page 3 of the instructions

If “Yes,” enter city and country of the separate foreign residence. Also, enter the number of days during your tax year that

you maintained a second household at that address. ©

List your tax home(s) during your tax year and date(s) established. ©

Next, complete either Part II or Part III. If an item does not apply, write “NA.” If you do not give

the information asked for, any exclusion or deduction you claim may be disallowed.

Taxpayers Qualifying Under Bona Fide Residence Test (See page 2 of the instructions.)

10 Date bona fide residence began © , and ended ©

11 Kind of living quarters in foreign country © Purchased house Rented house or apartment Rented room

Quarters furnished by employer

12a Did any of your family live with you abroad during any part of the tax year?

If “Yes,” who and for what period? ©

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.)

13a

b Are you required to pay income tax to the country where you claim bona fide residence? (See instructions.)

If you answered “Yes” to 13a and “No” to 13b, you do not qualify as a bona fide resident. Do not complete the rest of

this part.

If you were present in the United States or its possessions during the tax year, complete columns (a)–(d) below. Do not

include the income from column (d) in Part IV, but report it on Form 1040.

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(d) Income earned in

U.S. on business

(attach computation)

(c) Number of

days in U.S.

on business

(d) Income earned in

U.S. on business

(attach computation)

(c) Number of

days in U.S.

on business

(b) Date left

U.S.

(a) Date

arrived in U.S.

(b) Date left

U.S.

(a) Date

arrived in U.S.

15a List any contractual terms or other conditions relating to the length of your employment abroad. ©

b Enter the type of visa under which you entered the foreign country. ©

c Did your visa limit the length of your stay or employment in a foreign country? If “Yes,” attach explanation

Did you maintain a home in the United States while living abroad?

e If “Yes,” enter address of your home, whether it was rented, the names of the occupants, and their relationship

to you. ©

For Paperwork Reduction Act Notice, see page 1 of separate instructions. Cat. No. 11900P Form 2555 (1996)

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

©

3

4a

5

6a

c

8a

9

7

1 2

b

a

d

b

e

c

b

a

d

b c

d

d

b

Part I

Part II

General Information

b If you did not file Form 2555 or 2555-EZ after 1981 to claim either of the exclusions, check here © and go to line 7 now.

Of what country are you a citizen/national? ©

Attachment

Sequence No. 34

96
Form 2555 (1996) Page 2

Taxpayers Qualifying Under Physical Presence Test (See page 2 of the instructions.)

16 The physical presence test is based on the 12-month period from © through ©

17 Enter your principal country of employment during your tax year. ©

If you traveled abroad during the 12-month period entered on line 16, complete columns (a)–(f) below. Exclude travel between

foreign countries that did not involve travel on or over international waters, or in or over the United States, for 24 hours or

more. If you have no travel to report during the period, enter “Physically present in a foreign country or countries for the entire

12-month period.” Do not include the income from column (f) below in Part IV, but report it on Form 1040.

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(f) Income earned in U.S.

on business (attach

computation)

(e) Number of

days in U.S.

on business

(d) Full days

present in

country

(a) Name of country

(including U.S.) (b) Date arrived (c) Date left

All Taxpayers

Note: Enter on lines 19 through 23 all income, including noncash income, you earned and actually or constructively received during

your 1996 tax year for services you performed in a foreign country. If any of the foreign earned income received this tax year

was earned in a prior tax year, or will be earned in a later tax year (such as a bonus), see the instructions. Do not include

income from line 14, column (d), or line 18, column (f). Report amounts in U.S. dollars, using the exchange rates in effect

when you actually or constructively received the income.

If you are a cash basis taxpayer, report on Form 1040 all income you received in 1996, no matter when you performed

the service.

Amount 1996 Foreign Earned Income (in U.S. dollars)

19 Total wages, salaries, bonuses, commissions, etc. 19

20 Allowable share of income for personal services performed (see instructions):

a In a business (including farming) or profession 20a

b In a partnership. List partnership’s name and address and type of income. ©

20b

21 Noncash income (market value of property or facilities furnished by employer—attach statement

showing how it was determined):

a Home (lodging) 21a

b Meals 21b

c Car 21c

d Other property or facilities. List type and amount. © 

21d

22 Allowances, reimbursements, or expenses paid on your behalf for services you performed:

a Cost of living and overseas differential 22a

b Family 22b

c Education 22c

d Home leave 22d

e Quarters 22e

f For any other purpose. List type and amount. ©

22f

g Add lines 22a through 22f 22g

23 Other foreign earned income. List type and amount. ©

23

24 Add lines 19 through 21d, line 22g, and line 23 24

25 Total amount of meals and lodging included on line 24 that is excludable (see instructions) 25

Subtract line 25 from line 24. Enter the result here and on line 27 on page 3. This is your foreign

earned income ©

26

26

Part III

Part IV
Form 2555 (1996) Page 3

For Taxpayers Claiming the Housing Exclusion AND/OR Deduction

28 Qualified housing expenses for the tax year (see instructions) 28

Number of days in your qualifying period that fall within your 1996 tax

year (see instructions)

29

29

30 Multiply $25.25 by the number of days on line 29. If 366 entered on line 29, enter $9,242.00 here 30

31

Subtract line 30 from line 28. If zero or less, do not complete the rest of this part or any of

Part IX

31

32 Enter employer-provided amounts (see instructions) 32

Divide line 32 by line 27. Enter the result as a decimal (to two places), but do not enter more

than “1.00”

33

33

Housing exclusion. Multiply line 31 by line 33. Enter the result but do not enter more than the

amount on line 32. Also, complete Part VIII ©

34

34

Note: The housing deduction is figured in Part IX. If you choose to claim the foreign earned

income exclusion, complete Parts VII and VIII before Part IX.

For Taxpayers Claiming the Foreign Earned Income Exclusion

35 Maximum foreign earned income exclusion 35 $70,000 00

● All others, enter the number of days in your qualifying period that

fall within your 1996 tax year (see the instructions for line 29).

36

● Otherwise, divide line 36 by the number of days in your 1996 tax year and enter the result

as a decimal (to two places).

37

38 Multiply line 35 by line 37 38

39 Subtract line 34 from line 27 39

40 Foreign earned income exclusion. Enter the smaller of line 38 or line 39. Also, complete Part VIII © 40

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

41 Add lines 34 and 40 41

Deductions allowed in figuring your adjusted gross income (Form 1040, line 31) that are allocable

to the excluded income. See instructions and attach computation

42

42

Subtract line 42 from line 41. Enter the result here and in parentheses on Form 1040, line 21.

Next to the amount write “Form 2555.” On Form 1040, subtract this amount from your income

to arrive at total income on Form 1040, line 22 ©

43

43

For Taxpayers Claiming the Housing Deduction—Complete this part only if (a) line 31 is more than

line 34 and (b) line 27 is more than line 41.

44 Subtract line 34 from line 31 44

45 Subtract line 41 from line 27 45

46 Enter the smaller of line 44 or line 45 46

Note: If line 45 is more than line 46 and you could not deduct all of your 1995 housing deduction

because of the 1995 limit, use the worksheet on page 4 of the instructions to figure the

amount to enter on line 47. Otherwise, go to line 48.

47 Housing deduction carryover from 1995 (from worksheet on page 4 of the instructions) 47

48 Housing deduction. Add lines 46 and 47. Enter the total here and on Form 1040 to the left of

line 30. Next to the amount on Form 1040, write “Form 2555.” Add it to the total adjustments

reported on that line © 48

3 .

3 .

Part VIII

Part VII

Part VI

Part IX

Part V

36 ● If you completed Part VI, enter the number from line 29.

37 ● If line 36 and the number of days in your 1996 tax year (usually 366) are the same, enter “1.00.”

27

All Taxpayers

27 Enter the amount from line 26

Are you claiming the housing exclusion or housing deduction?

No. Go to Part VII.

%

%

Yes. Complete Part VI.