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

2004 2003 2002 .

Form 8840

Department of the Treasury

Internal Revenue Service

Closer Connection Exception Statement for Aliens

For the year January 1—December 31, 2004, or other tax year

beginning , 2004, and ending , 20 .

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

Type of U.S. visa (for example, F, J, M, etc.) and date you entered the United States  

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)  

During 2004, 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 2004?

Enter the name of the foreign country to which you had a closer connection than to the United States during 2004



Have you filed or will you file tax returns for 2004 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 (2004)

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, 2004, where was your tax home for the remainder of 2004?

Where was your tax home on January 1, 2004?

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 2004 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 Paperwork Reduction Act Notice, see page 4.

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. 2004
Form 8840 (2004) 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 2004 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 or Form W-8BEN (relating to 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 any of your responses to lines 14 through 32, attach a statement to this form.

Significant Contacts With Foreign Country or Countries in 2004

18 Where was your automobile(s) registered?

Part IV

14 Where was your regular or principal permanent home located during 2004 (see instructions)?

15 If you had more than one permanent home available to you at all times during 2004, list the location of each and

explain 

16 Where was your family located?

17 Where was your automobile(s) located?

Form 8840 (2004)
Purpose of Form

Form 8840 (2004) 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 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.

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 2004. You meet this test if you were

physically present in the United States

for at least:

● 31 days during 2004 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 2004,

● 183 days during the period 2004,

2003, and 2002, counting all the days of

physical presence in 2004 but only 1/3

the number of days of presence in 2003

and only 1/6 the number of days in 2002.

● You establish that during 2004, you

had a tax home in a foreign country, and

● You establish that during 2004, 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.

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.

4. 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.

5. 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, 2004, 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 (a) you were

present in the United States 183 days or

more in calendar year 2004 or (b) you

are a lawful permanent resident of the

United States (that is, you are a green

card holder).

Even though you would otherwise meet

the substantial presence test, you will

not be treated as a U.S. resident for

2004 if:

2. You changed your tax home during

2004 to a second foreign country.

3. You continued to maintain your tax

home in the second foreign country for

the rest of 2004.

5. You are subject to tax as a resident

under the tax laws of either foreign

country for all of 2004 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.

For more details on the substantial

presence test and the closer connection

exception, see 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 4

above), you must file Form 8843,

Statement for Exempt Individuals and

Individuals With a Medical Condition.

Note: You can download forms and

publications from the IRS website at

www.irs.gov.

When and Where To File

If you are filing a 2004 Form 1040NR or

Form 1040NR-EZ, attach Form 8840 to

it. Mail your tax return by the due date

(including extensions) to the address

shown in your tax return instructions.

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.

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 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.

If you do not have to file a 2004 tax

return, mail Form 8840 to the Internal

Revenue Service Center, Philadelphia,

PA 19255 by the due date (including

extensions) for filing Form 1040NR or

Form 1040NR-EZ.

3. Days you were temporarily in the

United States as a regular crew member

of a foreign vessel engaged in

transportation between the United States

and a foreign country or a possession of

the United States unless you otherwise

engaged in trade or business on such a

day.

Penalty for Not Filing Form

8840

If you do not timely file Form 8840, 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.
Form 8840 (2004) Page 4

Specific Instructions

Line 6

Line 14

Line 30

If you checked the “Yes” box on line 6,

do not file Form 8840. 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), 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 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 is considered

located in the United States, even

though the shares of stock are stored in

a safe deposit box in a foreign country.

Paperwork Reduction Act Notice. We

ask for the information on this form to

carry out the Internal Revenue laws of the

United States. 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.

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 9 min.

Preparing the form 1 hr., 27 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 Internal Revenue

Service, Tax Products Coordinating

Committee, SE:W:CAR:MP:T:T:SP, 1111

Constitution Ave. NW, Washington, DC

20224. Do not send the form to this

address. Instead, see When and Where

To File on page 3.

Copying, assembling,

and sending the

form to the IRS 34 min.

You are not required to provide the

information requested on a form that is

subject to the Paperwork Reduction Act

unless the form displays a valid OMB

control number. Books or records

relating to a form or its instructions must

be retained as long as their contents

may become material in the

administration of any Internal Revenue

law. Generally, tax returns and return

information are confidential, as required

by section 6103.

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