rom 2050 Application for Extension of Time
(Rev. Oct. 1975) for Filing U.S. Income Tax Return
Department of the, Treasury (For U.S. Citizens Abroad Who Expect to Qualify For Exempt Earned Income)
File in duplicate on or before the due date for filing your return. See instructions on reverse.

Name of taxpayer Your social security number
PI io
Print Number and street, or rural route ‘Spouse's social security number
or } }

Type | City or town, State, and ZIP code or country

1. | request an extension of time until -... ...- to file my income tax return

for the year ended _... .. because ! expect to qualify for exemption on my
income earned in foreign countries during that year for the reason stated below (Check one):
(a) [1] Bona fide residence in a foreign country or countries for uninterrupted period which includes an entire taxable year.

(b) [] Physical presence in a foreign country or countries for 510 full days of any 18-consecutive-month period.
2. Has an extension of time to file been previously granted for this taxable year?. . . . . . . . « « + « [] Yes [J] No

3. (a) Date of first arrival in foreign country --..
(b) Date qualifying period begins _.
(c) Your address of residence in this foreign country
(d) Date of expected return to United States -...

4. Last permanent address in United States

5. Office where you filed your last return (city and State) .

6. Occupation (if self-employed, describe fully) ..

7. (a) Name and United States address of employer

(b) Foreign address of employer

CAUTIONARY NOTE: .

A. Election to have the Internal Revenue Service compute the income tax is not available to the taxpayer with, or without, an
extension, if the return is filed after the regular due date.

B. Interest accrues on any tax due from the regular due date of the return until paid. For the rate of interest and amount of penalty due
to late payment of tax, see Requirements for Filing in the instructions.

Signature and Verification
If Prepared by Taxpayer
Under penalties of perjury, | declare that to the best of my knowledge and belief, the statements made herein are true and correct.

Signature of taxpayer .... Date.

Spouse's signature ._.. Date

If Prepared by Someone Other Than Taxpayer
Under penalties of perjury, | declare that to the best of my knowledge and belief, the statements made herein are true,

correct, and complete, that | am authorized by the taxpayer to prepare this application, and that | am:

(J A member in good standing of the bar of the highest court of (specify jurisdiction) _

CO A certified public accountant duly qualified to practice in (specify jurisdiction) _

LA person enrolled to practice before the Internal Revenue Service.

[J A duly authorized agent holding a power of attorney. (The power of attorney need not be submitted unless requested.)

[J A person standing in close personal or business relationship to the taxpayer who is unable to sign this application because of ill-
ness, absence, or other good cause. My relationship to the taxpayer and the reasons why the taxpayer is unable to sign this
application are __

Signature of preparer other than taxpayer _

The Internal Revenue Service will indicate below whether the extension is granted or denied and return the original.

Notice to Applicant—To Be Completed By the Internal Revenue Service

LD The application IS approved. (Please attach this form to the return.)

[J The application IS NOT approved.
Careful consideration has been given to the reasons stated in your application and it has been determined that the extension is
not warranted.

[J The application cannot be considered since it was filed after the due date of the return.

LO Other _

Date

16—82597-1



If the original copy of this application is to be returned to the taxpayer at an address other than that shown on page 1, or to an
agent acting for the taxpayer, please complete the section below:

Name
Please
Print Number and street
or
Type

City or town, State, and ZIP code

If possible, read Publication 54, Tax Guide for U.S. Citizens Abroad, before completing this application or filing your United States
income tax return. You can get copies from offices of District Directors of Internal Revenue, from most United States embassies and
consulates, or by writing to the Internal Revenue Service Center, 11601 Roosevelt Boulevard, Philadelphia, Pennsylvania 19155, U.S.A.

Requirements for Filing.—If you are a
U.S. citizen (or a resident alien from a
country whose income tax treaty with the
United States qualifies you to the benefits
of section 911(a)(2) of the Code to the
same extent as a U.S. citizen) and you re-
ceived earned income for personal services
rendered in a foreign country or countries,
you may obtain an extension of time to file
your United States income tax return. This
is in addition to the two month extension
granted to U.S. citizens residing or travel-
ing outside the United States and Puerto
Rico.

You may be granted an extension to 30
days beyond the date upon which you can
reasonably expect to qualify for the ex-
emption of this earned income if you are
either a bona fide resident of a foreign
country or physically present in the foreign
country for an 18-month period. An exten-
sion of time for filing is a privilege which
will not be granted if your application is
incomplete.

An extension of time to file a return, un-
less it specifies otherwise, does not extend
the time for payment of the tax. The law
imposes a penalty for the late payment of
tax (other than estimated tax) of one-half
percent a month or part of a month, un-
less you can show reasonable cause for
failure to pay on time.

Interest, which accrues from the regular
due date of the return until the tax is paid,
is charged whether or not an extension is
granted. The interest will not be excused
even if you show reasonable cause. The law
provides for periodic adjustments of the
interest rate, which is 9 percent before
February 1, 1976, and 7 percent for
amounts outstanding on such date or aris-
ing thereafter.

Where to File—Complete in duplicate
and file this application with either:

(a) The Internal Revenue Service Cen-

ter, 11601 Roosevelt Boulevard,
Philadelphia, Pennsylvania 19155,

(b) The local Internal Revenue Service
Representative or other Internal
Revenue Service Employee.
Definition of Bona Fide Resident (Sec.
911(a)(1) of the Internal Revenue Code.) —

(a) General—lIf you are a U.S. citi-
zen who is a bona fide resident of a for-
eign country or countries for an uninter-
rupted period which includes an entire tax-
able year you may consider as exempt
certain amounts of earned income derived
from personal services rendered abroad.
For each of the first three consecutive
years of bona fide foreign residence, you

Instructions

may exclude no more than $20,000 of
earned income derived during each year.
The maximum exclusion per year of bona
fide, foreign residence following the first
three consecutive years is $25,000. There
are certain conditions under which you may
not consider earned income as exempt,
regardless of your bona fide foreign resi-
dence status. Instructions under Special
rules applicable to bona fide residence
and physical presence cover these restric-
tions.

(b) Determination of Residence.—No
specific rule can be stated for determining
whether a U.S. citizen is a bona fide res-
ident of a foreign country, since the de-
termination involves your intentions re-
garding the length and nature of your stay.
Your intention to establish a bona fide resi-
dence in a foreign country may be evi-
denced by words and acts, but where they
conflict, more emphasis will be placed on
the acts than on the words. Generally, if
you go to a foreign country for a definite,
but temporary purpose, and return to the
United States after you have accomplished
the purpose, you are not a bona fide resi-
dent of that foreign country. However, if an
extended and indefinite stay is necessary
for you to accomplish the purpose, and to
that end you make your home in the for-
eign country, you may be a bona fide resi-
dent of the foreign country for Federal
income tax purposes. The term “foreign
country” does not include a possession of
the United States.

(c) Statement of Nonresidence.—If you
have earned income from a foreign country
and you have indicated to the authorities of
that country that you are not a resident
there and so have not been subject to that
country’s income tax, you may not be
treated as a bona fide resident of that for-
eign country. If you have made this state-
ment and, as of any date a determination
is being made about whether you qualify
as a bona fide foreign resident, no adverse
determination has been made by the
authorities of the foreign country about
your nonresidence status, you will be con-
sidered to have been held not subject to
the income tax of that foreign country.

Definition of those Physically Present in
Foreign Countries (Sec. 911(a)(2) of the
Internal Revenue Code).—

(a) General—If you are a U.S. citi-
zen (or a resident alien from a country
whose income tax treaty with the United
States qualifies you to the benefits of this
section of the Code to the same extent it
applies to U.S. citizens) physically pres-
ent in a foreign country or countries for

‘fr US. GOVERNMENT PRINTING OFFICE : 1975—-O-575-134

a total of at least 510 full days during any
period of 18 consecutive months you may,
subject to the special rules set forth below,
exclude up to $20,000 of your earned in-
come for each taxable year if the earned
income is for services performed outside
the United States and is attributable to the
18-month period.

(b) Determination of 18-month Period
and Application of 510-day Rule.—In com-
puting the minimum of 510 full days pres-
ence in any foreign country or countries,
all separate periods of such presence dur-
ing the 18-month period are to be totaled.
The 510 full days need not be consecutive,
but may be interrupted by periods during
which you are traveling over international
waters or are otherwise not present in a
foreign country.

Special Rules Applicable to Bona Fide
Residence and Physical Presence.—

(a) Rule of Attribution.—For purposes
of determining the exemption, earned in-
come (whether received before, during, or
after the taxable year in which the services
to which the amounts are attributable are
performed) is considered received in the
taxable year in which the services to which
the amounts are attributable are per-
formed. This rule applies only in determin-
ing the amount of the exemption and does
not affect the time of reporting any
amounts which are not exempt from tax.
In no case will amounts be attributed to
any year in which the services performed
are insubstantial in nature.

(b) Requirement as to Time of Re-
ceipt.—To be exempt, earned income must
be received before the close of the taxable
year following the taxable year in which
the services to which the amounts are
attributable are performed.

(c) Treatment of Amounts Paid by U.S.
Government, etc.—Earned income paid by
the United States or any of its agencies
or instrumentalities is not exempt from tax
under the bona fide residence or physical
presence tests.

Requests for Any Other Reason.—To re-
quest an extension of time to file for any
reason other than the fact that you expect
to qualify for exempt income earned
abroad, you should file an application on
Form 2688.

Cautionary Note
The Internal Revenue Code provides for

a penalty for underpayment of estimated
tax. If you fail to qualify under either of
the definitions stated above for excluding
income from your return, you may be lia-
ble for this penalty. (See Publication 54.)
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