Form 8840

Department of the Treasury

Internal Revenue Service

Closer Connection Exception Statement for Aliens

For the year January 1—December 31, 1995, or other tax year

beginning , 1995, and ending , 19 .

OMB No. 1545-1410

Your first name and initial

Fill in your

addresses only if

you are filing this

form by itself and

not with your U.S.

tax return

Your U.S. taxpayer identification number, if any

General Information

1

2

3

4

5

6

7

8

Enter your U.S. visa number, if any © 

Of what country or countries were you a citizen during the tax year?

What country or countries issued you a passport?

Enter your passport number(s) © 

Enter the number of days you were present in the United States during:

1995 1994 1993 .

During 1995, did you apply for, or take other affirmative steps to apply for, lawful permanent resident

status in the United States or have an application pending to change your status to that of a lawful

permanent resident of the United States (see instructions)?

Closer Connection to One Foreign Country

9

10

11

12

Where was your tax home during 1995?

Enter the name of the foreign country to which you had a closer connection than to the United States during 1995

©

Have you filed or will you file tax returns for 1995 in the countries listed on lines 9 and 10?

If “Yes” to either line 12 or line 13, attach verification.

Yes No

Yes No

13

Cat. No. 15829P Form 8840 (1995)

Part III

Part I

Part II

Closer Connection to Two Foreign Countries

Yes No

Next, complete Part IV on the back.

After changing your tax home from its location on January 1, 1995, where was your tax home for the remainder of 1995?

Where was your tax home on January 1, 1995?

Did you have a closer connection to each foreign country listed on lines 9 and 10 than to the United

States for the period during which you maintained a tax home in that foreign country?

If “No,” attach an explanation.

Were you subject to tax as a resident under the internal laws of (a) either of the countries listed on lines

9 and 10 during all of 1995, or (b) both of the countries listed on lines 9 and 10 for the period during

which you maintained a tax home in each country?

Yes No

For Privacy Act and Paperwork Reduction Act Notice, see page 3.

Attachment

Sequence No. 101

If “No” to either line 12 or line 13, please explain ©

Last name

Address in country of residence Address in the United States

Next, complete Part IV on the back.

© Attach to Form 1040NR or Form 1040NR-EZ.
Form 8840 (1995) Page 2

19

20

Where were your personal belongings, furniture, etc., located?

27

28

Sign here

only if you

are filing

this form by

itself and

not with

your U.S.

tax return

Under penalties of perjury, I declare that I have examined this form and the accompanying attachments, and to the best of my knowledge and

belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any

knowledge.

© Your signature Date ©

List social, cultural, religious, and political organizations you currently participate in and the location of each:

Location

Location

a

b

Did you conduct business activities in a location other than your tax home?

If “Yes,” where?

Where was your driver’s license issued?

If you hold a second driver’s license, where was it issued?

Where were you registered to vote?

22 Yes No

23a

24

b

In what country/countries did you keep your personal, financial, and legal documents?

From what country/countries did you derive the majority of your 1995 income?

30 In what country/countries were your investments located (see instructions)?

c Location

d Location

e Location

21 Where was the bank(s) with which you conducted your routine personal banking activities located?

a c

b d

25 When completing official documents, forms, etc., what country do you list as your residence?

26 Have you ever completed:

Form W-8, Certificate of Foreign Status? Yes No

Form W-9, Request for Taxpayer Identification Number and Certification? Yes No

Form 1078, Certificate of Alien Claiming Residence in the United States? Yes No

Any other U.S. official forms? If “Yes,” indicate the form(s) © Yes No

a

b

c

d

31 List any charitable organizations to which you made contributions and their locations:

Location

Location

a

b

c Location

d Location

32 Did you qualify for any type of government-sponsored “national” health plan? Yes No

If “Yes,” in what country?

If “No,” please explain ©

29 Did you have any income from U.S. sources? Yes No

If “Yes,” what type?

If you have any other information to substantiate your closer connection to a country other than the United States or you

wish to explain in more detail your response to lines 14 through 32, attach a statement to this form.

Significant Contacts With Foreign Country or Countries in 1995

18 Where was your automobile(s) registered?

Part IV

14 Where was your regular or principal permanent home located during 1995 (see instructions)?

15 If you had more than one permanent home available to you at all times during 1995, list the location of each and

explain ©

16 Where was your family located?

17 Where was your automobile(s) located?
Privacy Act and

Paperwork Reduction

Act Notice

We ask for the information on this

form to carry out the Internal

Revenue laws of the United States.

Internal Revenue Code section

7701(b) and its regulations require

that you give us the information. We

need it to determine if you meet the

closer connection exception to the

substantial presence test. If you do

not give us the information, you may

be treated as a U.S. resident for

U.S. income tax purposes.

The time needed to complete and

file this form will vary depending on

individual circumstances. The

estimated average time is:

Recordkeeping 13 min.

Learning about the law

or the form 7 min.

Preparing the form 1 hr., 14 min.

If you have comments concerning

the accuracy of these time

estimates or suggestions for making

this form simpler, we would be

happy to hear from you. You can

write to the Tax Forms Committee,

Western Area Distribution Center,

Rancho Cordova, CA 95743-0001.

DO NOT send the form to this

address. Instead, see How To File

on page 4.

Purpose of Form

Form 8840 (1995) Page 3

General Instructions

Who Must File

If you are an alien individual and you

meet the closer connection

exception to the substantial

presence test, you must file Form

8840 or a similar statement with the

IRS to establish your claim that you

are a nonresident of the United

States by reason of that exception.

Section references are to the U.S.

Internal Revenue Code unless

otherwise noted.

Use Form 8840 to claim the closer

connection to a foreign country(ies)

exception to the substantial

presence test. The exception is

described in Regulations section

301.7701(b)-2.

Substantial Presence Test

You are considered a U.S. resident if

you meet the substantial presence

test for 1995. You meet this test if

you were physically present in the

United States for at least:

● 31 days during 1995, and

2. Days you were in the United

States for less than 24 hours when

you were traveling between two

places outside the United States.

Closer Connection

Exception

● You were present in the United

States for fewer than 183 days

during 1995,

● 183 days during the period 1995,

1994, and 1993, counting all the

days of physical presence in 1995

but only 1/3 the number of days of

presence in 1994 and only 1/6 the

number of days in 1993.

● You establish that during 1995 you

had a tax home in a foreign country,

and

● You establish that during 1995 you

had a closer connection to one

foreign country in which you had a

tax home than to the United States,

unless you had a closer connection

to two foreign countries.

Copying, assembling,

and sending the

form to the IRS 35 min.

Days of Presence in the United

States.—Generally, you are treated

as being present in the United

States on any day that you are

physically present in the country at

any time during the day. However,

you do not count the following days

of presence in the United States for

purposes of the substantial

presence test.

1. Days you regularly commuted

to work in the United States from a

residence in Canada or Mexico.

3. Days you were unable to leave

the United States because of a

medical condition or medical

problem that developed while you

were in the United States.

4. Days you were an exempt

individual.

Closer Connection To Two Foreign

Countries

You may demonstrate that you have

a closer connection to two foreign

countries (but not more than two) if

all five of the following apply.

1. You maintained a tax home as

of January 1, 1995, in one foreign

country.

4. You had a closer connection to

each foreign country than to the

United States for the period during

which you maintained a tax home in

that foreign country.

Note: You are not eligible for the

closer connection exception if 

(1) you were present in the United

States 183 days or more in calendar

year 1995, or (2) you are a lawful

Even though you would otherwise

meet the substantial presence test,

you will not be treated as a U.S.

resident for 1995 if:

2. You changed your tax home

during 1995 to a second foreign

country.

3. You continued to maintain your

tax home in the second foreign

country for the rest of 1995.

5. You are subject to tax as a

resident under the tax laws of either

foreign country for all of 1995 or

subject to tax as a resident in both

foreign countries for the period

during which you maintained a tax

home in each foreign country.

Tax Home

Your tax home is your main place of

business, employment, or post of

duty regardless of where you

maintain your family home. If you do

not have a regular or main place of

For more details on the substantial

presence test and the closer

connection exception, get Pub. 519,

U.S. Tax Guide for Aliens.

In general, an exempt individual

is a (a) foreign government-related

individual, (b) teacher or trainee, 

(c) student, or (d) professional

athlete competing in a charitable

sports event. For more details, see

Pub. 519.

Note: If you qualify to exclude days

of presence in the United States

because you were an exempt

individual (other than a foreign

government-related individual) or

because of a medical condition or

medical problem (see item 3 earlier),

you must file Form 8843, Statement

for Exempt Individuals and

Individuals With a Medical Condition,

or a similar statement.

We may give this information to

the Department of Justice as

provided by law. We may also give it

to cities, states, and the District of

Columbia for use in administering

their tax laws.

permanent resident of the United

States (i.e., green card holder).
Form 8840 (1995) Page 4

How To File

Attach Form 8840 to your 1995

income tax return. If you do not

have to file a return, send the form

to the Internal Revenue Service

Center, Philadelphia, PA 19255 by

the due date (including extensions)

for filing Form 1040NR or Form

1040NR-EZ. See the Instructions for

Form 1040NR or Form 1040NR-EZ.

Penalty for Not Filing Form

8840 or a Similar Statement

If you do not timely file Form 8840

or a similar statement, you will not

be eligible to claim the closer

connection exception and may be

treated as a U.S. resident.

You will not be penalized if you

can show by clear and convincing

evidence that you took reasonable

actions to become aware of the

filing requirements and significant

steps to comply with those

requirements.

Printed on recycled paper

Specific Instructions

Line 6

If you do not qualify for

nonresident status by reason of a

treaty, file your U.S. income tax

return using Form 1040.

Line 14

Line 30

If you answered “Yes” on line 6, do

not complete this form. You are not

eligible for the closer connection

exception. However, you may qualify

for nonresident status by reason of a

treaty. See Pub. 519 for details. If

so, file Form 8833, Treaty-Based

Return Position Disclosure Under

Section 6114 or 7701(b), or a similar

statement, with your Form 1040NR

or Form 1040NR-EZ.

A “permanent home” is a dwelling

unit (whether a house owned or

rented, an apartment, or a furnished

room) that is available at all times,

continuously and not solely for short

stays.

For intangible assets, such as

stocks and bonds, indicate the

country of origin of the stock

company or debtor. For example, if

you own shares of a U.S. publicly

traded corporation, the investment

would be considered located in the

United States, even though the

shares of stock are stored in a safe

deposit box in a foreign country.

Establishing A Closer Connection

You will be considered to have a

closer connection to a foreign

country than to the United States if

you or the IRS establishes that you

have maintained more significant

contacts with the foreign country

than with the United States.

business because of the nature of

your work, then your tax home is the

place where you regularly live. If you

do not fit either of these categories,

you are considered an itinerant and

your tax home is wherever you

work.