. OMB No. 1545-0067
Form 2 5 5 5 Foreign Earned Income -— an —
Department of the Treasury > See separate instructions. Attach to Form 1040. | g 8 3
Internal Revenue Service 34

For Use by United States Citizens and Resident Aliens Only
Name of taxpayer ‘Social security number
Foreign address (including country) Your occupation
Name of employer >
Employer's |_U.S. >
address Foreign >
Employer is (check , LI A foreign entity CLAUS. company
any that apply) OA foreign affiliate of a U.S. company O Self CO Other (specify) >
Test under which you qualify to claim CO Bona fide residence test. (Part !) Are youa
the exclusion(s) and/or deduction O Physical presence test. (Part Il) U.S. citizen? . . . .O Yes O1No

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

yourtaxhome? .. .... . .0 Yes O No
If “Yes,” give city and country of the separate foreign ‘residence. Also show ‘the number of ‘days during your tax year that you maintained a
second household at that address

Complete either Part | or Part II. 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.

PART 1.—Taxpayers Qualifying Under Bona Fide Residence Test. (See instructions.)

1 Date bona fide residence began. eee eee eee , ended .

2. Kind of living quarters in foreign country » [1 Purchased house CO Rented house or apartment Rented room
O Quarters furnished by employer

3 Did any of your family live with you abroad duringany partofthetaxyear? . . . . ........ =. .OYes 0 No

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.) . . . . » . . .OYes O No
b Are you required to pay income tax to the country where you claim bona fide residence? Gee instructions. ) . . .OYes O No
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 show this income in Part Ill,
but report it on Form 1040.)

Number of ] Income earned in US. Number of | Income earmedinUS.
Date arrived Date left days in US. ‘on business (attach Date arrived Date eft days in U.S. ‘on business (attach
7 on business computation) on business computation)

6a State any contractual terms or other conditions relating to the length of your employment 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 inaforeigncountry? . ....... =... . .O0Yes CNo
If “Yes,” attach explanation.

d Did you maintain a home in the U.S. while living abroad? : .
If “Yes,” show address of your home, whether it was rented, and the names sand relationships of the occupants. .

For Paperwork Reduction Act Notice, see page 1 of separate instructions. Form 2555 (1983)


Form 2555 (1983) Page 2

PART II.—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, except travel between foreign countries that did not involve travel
on, or over, international waters 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 that you were physically present
in a foreign country or countries during the entire 12-month period. (Do not show in Part Ill the income that you list here, but report it
on Form 1040.)

Name of country
including U.S.)

Fulldays | Number of |” Income earned U.S. on
Date arrived Date left presentin | days in U.S. business (attach
country _| on business computation)

PART III.—All Taxpayers

Note: On lines 10 through 17 enter all income, including noncash income, that you earned and actually or constructively received during
1983 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 (such as a bonus), see the instructions. Do not include income from Part |, line 5, or Part Il, line 9. Report amounts in
U.S. dollars, using the exchange rates in effect when you actually or constructively received the income.

On Form 1040 report all income you received during 1983 no matter when you performed the service.

Amount

1983 Foreign Earned Income (in US. dollars)
10 Total wages, salaries, bonuses, commissions, etc. : 10
11 Allowable share of income for personal services performed (see instructions):
lla

a In business (including farming) or profession
b Ina partnership (give name, address, and nature of income) .

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

how determined):

a Home (lodging) . 12a
b Meals 12b
eCar . : 12¢
d Other property or facilities (specify) _ -
12d
13

14 Allowances, reimbursements, or expenses paid on your behalf for services you Performed: =
a Cost of living and overseas differential 4a
b Family . Le tab [==
cEducation 2. 14c
dHomeleave. . 2 2. 2. ee ee 14d =
e Quarters l4e
f For any other purpose se (specify) _ —
14f
gAddlines ldathroughl4f 2. ee es [M
15 Addlines 10throughl3andlinel4g . . 2... ee LES.
16 Value of meals and lodging included on line 12a or b that are excludable. (See instructions.) . 16
17 Subtract line 16 from line 15. This is your foreign earned income . . . . P| 17

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 (1983)

Page 3

PART IV.—For Taxpayers Claiming Housing Exclusion AND/OR Deduction

18 Qualified housing expenses for the tax year. (See instructions.) 18
19 Number of days in your qualifying period that fall within your 1983 tax year. (See

instructions.) . 19
20 Multiply $18.10 by the number of days or online 19, ‘but do >not e enter more 2than $6, “604.00 toe. [20
21 Subtract the amount on line 20 from the amount on line 18. (If zero or less, do not complete the rest of Part

Wor any of Part VII.) . . 21
22 Enter employer-provided amounts. (See instructions.) 22 i=
23 Enter the amount from line 17 . 23 =
24 Divide the amount on line 22 by the amount on line 23 and enter the percentage here. (Limited to 100%. y 24
25 Housing exclusion. Multiply the amount on line 21 by he percentage on on line 24, but do not enter more than

the amount on line 22. Also enter this amount on line 35 p> | 25
Note: /f the amount on line 21 is more than the amount on line 25, complete fine 26. Otherwise, skip. to Part V if you choose to claim the

foreign earned income exclusion.

26 Subtract the amount on line 25 from the amount on line 21 and enter here and on line 40, Part Vil. | Complete Part

V before Part Vil, if you choose to claim the foreign earned income exclusion.) . 26

PART V.—For Taxpayers Claiming Foreign Earned Income Exclusion

27 Maximum foreign earned income exclusion .

27 |$80,000 {00

28 Number of days in your qualifying period that fall within y your 11983 tax ye year. r. (See

instructions forline19.). . . . 28
29 Divide the number of days on line 28 by the number of days in your tax: year (usually 365) and enter the
percentage here. . 29 .
30 Multiply the amount on line 27 by the percentage on ‘line 29 . 30
31 Enterthe amountfromline17. . 2 2. LS
32 Enter the amount from line 25 . Loe . 32 —=
33 Subtract the amount on line 32 from the amount ¢ on line 31 : rere a
34 Foreign earned income exclusion. Enter here and on vline 36, Part V Vi, the amount from line 30 or line 33,
whichever is less soe | 84

PART VI.—For Taxpayers Claiming Housing Exclusion, Foreign Earned Income Exclusion, or Both

35 Housing exclusion fromline25. . . . . Cee ee ee ee £85

36 Foreign earned income exclusion from line 34. 36

37 Add the amounts on lines 35 and 36 .

37

38 Deductions allocable to excluded income. (See instructions and attach computation. )

38

39 Subtract line 38 from line 37. Enter the result here and in parentheses on Form 1040, line 21. Next to the
amount write “Exclusion(s) from Form 2555.” On Form 1040 subtract the amount from your income to
arrive at totalincome onForm1040,line22,. we

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PART VII.—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 . 40

41 Enter the amount from line 17 . al

42 Enter the amount from line 37 . 4

43 Subtract the amount on line 42 from the amount on line 41 43
44

44 Enter the amount from line 40 or line 43, whichever is less.

Note: /f the amount on line 43 is more than the amount on line 44 and you could not deduct all of your 1982 housing deduction because
of the limitation, complete the worksheet on page 4 of the instructions to figure how much of your1982 housing deduction may be

carried over to 1983. Otherwise, enter a zero (-O-) on line 45.

45 Housing deduction carryover from 1982 (from worksheet on page 4 of the instructions)
46 Add the amounts on lines 44 and 45. Enter here and on Form 1040 to the left of line 31. Next to the amount

45

on Form 1040 write ‘Deduction from Form 2555.” Add it to the total adjustments reported on that line. >

46