‘orm 2555 Forei n Earned Income | _OMB I No. No. 1545-0067
5 r~<990

Department of the Treasury > See separate Instructions.» Attach to front of Form 1040. Attachment
interna! Revenue Service Sequence No. 34

For Use by United States Citizens and Resident Aliens Only

Yourname Your social security number

Foreign address (including country) Your occupation

Name of employer >
Employer's |_U.S. > - .
address Foreign > - _

Employer is (check > D A foreign entity (1 AU,S. company

any that apply) CIA foreign affiliate ofaU.S.company _) Self C1 Other (specify) >

Enter earlier years (after 1981) that you filed Form 2555 to claim either of the exclusions ®

If you chose to claim an exclusion in an earlier year (after 1981), have you revoked yourchoice?. . . . . . . . . .OYes CINo
If "Yes,” give the type of exclusion and the tax year for which the revocation was effective > .

Test under which you qualify to claim the » C Bona fide residence test (Part |) Are youa
exclusion(s) and/or deduction O Physical presence test (Part li) |_US. citizen? . . . DO Yes [No

Did you maintain a separate foreign residence for your family because of adverse ting conditions at your tax home? (See

Second Foreign Household on page 3 of the Instructions.) . rn . a Loe .. .0 Yes ONo
If “Yes,” give city and country of the separate foreign residence. Also show the number fof days during your tax year that you maintained a
second household at that address .

Compiete 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 Date bona fide residence began
2 Kind of living quarters in foreign country » [] Purchased house
© Quarters furnished by employer
3 Did any of your family live with you abroad during any part of the taxyear? i os |)
If 'Yes,"’ who and for what period? >
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.) . . . a oo... . . OY¥es OONo
b Are you required to pay income tax to the country where you claim bona fide residence? (See Instructions. )... . Yes ONo
If “Yes” to 4a and “No” to 4b, you do not qualify as a bona fide resident. Do not complete the rest of Part I.

5 Complete the following for days present in the United States or its possessions during the tax year. (Do not Include the income
fro column (d) below in Part |I!, but report it on Form 1040.)

OiRented house or apartment

(e) Number of | (d) Income earned in U.S.

1 (e)Number of | (€) Income eamed in U.S |
(9) Data arnvec | (b) Deteloft | “gays inUS. on business (attach (9) Date arrived Cb) Gatetert | “days in US. on business (attach
vs con business computation) - 8. on business computation)

a

6a State any contractual terms or other conditions relating to the length of your emplayment 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 ina foreign country? . . . sone oe . .OYes ONo
If Yes," attach explanation.
d Did you maintain a home in the United States while living abroad? . . .. . OYes ONo

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. Form 2555 (1990)


Foem 2555 (1990) Page 2

GEM Taxpayers Qualifying Under Physical Presence Test (See Instructions.)

7 The physical presence test is based on the 12-month period from _

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. 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 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 below that you were physically present in a foreign country or countries during the entire 12-month period. (Do not include
the income from column (f) below in Part lil, but report it on Form 1040.)

J (d) Full days_| (e) Number of | (f) Income earned in U.S. on

Oramoee (b) Date arrived (6) Dateieft present in | days inU.S. on] business (attach
ne country business computation)

Note: On lines 10 through 14 enter all income, including noncash income, that you earned and actually or constructively received during
your 1990 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
jine 5, column (d), or fine 9, column (f). Report amounts in U.S. dollars, using the exchange rates in effect when you actually or
constructively received the income.
ityou are a cash basis taxpayer, report on Form 1040 all income you received during 1990, no matter when you performed
the service.

All Taxpayers

1990 Foreign Earned Income (in jets)
10 Total wages, salaries, bonuses, commissions, ete. an » 10
11 Allowable share of income for personal services performed (see Instructions):
a Ina business (including farming) or profession lla
b Ina partnership (give name, address, and nature of income) .
PT
12 Noncash income (market value of property or facilities furnished by employer-—attach statement showing y
how it was determined):
a Home(lodging). 2. 2 2 we ry
b Meals rn 12b
¢ Car. 12¢
d Other property or ‘facilities (specify)
12d a
13 Allowances, reimbursements, or expenses paid on your behalf for services you performed:
a Cost of living and overseas differential. . . . ........., . {13a
bFamiy. ee ee, [8D
¢ Education . : 13¢
d Homeleave oe ee ee. {BT
e Quarters . 2. toe . 13e
t For any other purpose (specify) -
13f
& Add lines 13a through 13f and enter the total 13g
14 Other foreign earned income (specify)
14
15 Add lines 10 through 12d, line 13g, and line 14 andenterthetotal . . | | . es i) 7
16 Total amount of meals and lodging included on line 15 that is excludable, (See Instructions.) 16
17__ Subtract line 16 from line 15 and enter the result. This is your forelgnearnedincome . ._ Ph 117

Goto page 3. Complete Part IV next if you choose to claim the housing exclusion or are claiming the housing deduction.
Otherwise, skip to Part V.



Form 2555 (1990)

Page 3

For Taxpayers Claiming Housing Exclusion AND/OR Deduction

18 Qualified housing expenses for the tax year. (See Instructions.)

19 Number of days in your qualifying period that fall within your 1990 tax year. Gee
Instructions.) . . 19

20 Multiply $21.30 by the number of days on line 19. Enter the result, but do not enter more than $7,775.00
21 Subtract line 20 from line 18. (If the result is zero or less, do not complete the rest of Part IV or any of Part Vil.)

22 Enter employer-provided amounts. (See Instructions.) 22

18

20

23 Enter the amount fromline17. . |. . (23
24 Divide the amount on line 22 by the amount on “line 23 and ‘enter: the result asa decimal Mto two laces).

(Limited to 1.00.) . 24 x.
25 Housing exclusion. Multiply the amount online 21 1 by the decimal amount on line 24. Enter the result, but
do not enter more than the amount on line 22. Also enter this amount en line 35 25

Note: /f the amount on line 21 is more than the amount on line 25, complete line 26. Otherwise, ‘skip to Part 7 if you choose to claim the

foreign earned income exclusion.

26 Subtract line 25 from line 21. Enter the result here and on line 40. (Complete Parts V Vand vi before Part VIL if you
choose to claim the foreign earned income exclusion.). :

26

For Taxpayers Claiming Foreign Earned Income Exclusion

27 Maximum foreign earned income exclusion
28 Number of days in your qualifying | period that fall within your 1990 tax Year. (Gee

27 [$70,000] 00

Instructions forline 19.) . . soe | 8
29 Divide the number of days on line 28 by the number of aay in your 1990 tax year (usually 365) and enter the

result as a decimal (to twoplaces). . . . . Sees | 29 x
30 Multiply the amount on line 27 by the decimal amount! on line 29 oe 30
31 Enterthe amountfromline17 2. 2 31
32 Enter the amount fromline25 . . 32
33 Subtract line 32 from line 31. Enter the result. : ce 33
34 Foreign earned income exclusion. 1. Compare | the amounts on lines 30 and 33. Enter the smaller of the two
amounts here and online 36. a | 84

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

35 Housing exclusion fromline25. . . |. . soe Fe . 35 7), }
36 Foreign earned income exclusion from line 34 a 1)
37 Add lines 35 and 36 and enter the total . 37
38 Deductions allowed in figuring your adjusted gross income 2 (Form 1040, line 31) that are allocable to te
excluded income. (See Instructions and attach computation.) . 38
39 Subtract line 38 from line 37. Enter the result here and in parentheses 0 on Form 1040, fine 22. Next t 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, line23 . . . . . ss we woe ee a 1)

For Taxpayers Claiming Housing Deduction

Note: Complete this part only if: (1) you entered an amount on line 26, and (2) the amount on line 17 is more than the amount on line 37.

40 Enter the amount from line 26. AQ

41 Enter the amount from line 17

42 Enter the amount from line 37.

43 Subtract line 42 from line 41 and enter the result 43 _
44 Compare the amounts on lines 40 and 43. Enter the smaller of the two amounts here . 44

Note: /f the amount on line 43 is more than the amount on line 44 and you could not deduct all of your 1989 9 housing deduction because
of the 1989 limitation, complete the worksheet on page 4 of the Instructions to figure how much of your 1989 housing deduction

may be carried over to’ 1990. Otherwise, enter -O- on line 45.

45 Housing deduction carryover from 1989 (from worksheet on page 4 of the Instructions) 45
46 Add lines 44 and 45. Enter the total here and on Form 1040 to the left of fine 30. Next to the amount on
Form 1040 write ‘Deduction from Form 2555." Add it to the total adjustments reported on thatline . . » | 46

3TUS, GOVERNMENT PRIVTING OFFICE: 1990 -265-300