EFTA01222566.pdf

ronn1040NR U.S. Nonresident Alien Income Tax Return OMB No. 154S-0074 Do Go to vnweirs.gov/Form1040NR for instructions and the latest information. Department of the Treasury Internal Revenue Service begeming For the year January 1-December . 2018. and ending 31. 2018. or other tax year .20 018 Your first ame and initial Last name Identifying number (see instructions) Present home address (number and street or rural route). If you have a P.O. box. see instructions. Apt. no. Check if: 0 Individual Please print O Estate or Trust or type City. town or post office. state. and ZIP code. If you have a foreign address. also complete spaces below. See instructions. Foreign country name I Foreign province/state/county Foreign postal code Filing 1 0 Reserved 4 • Reserved Status 2 0 Single nonresident alien 5 • Married nonresident alien 3 0 Reserved 6 • Qualifying widow(er) (see instructions) Check onty one box. Child's name Ito Dependents 7 Dependents: (see Instructions) (2) Dependent's (3) Dependent's (4)s, if qualifies for (see inst.): If more identifying number relationship to you (1) First name Last name Chid tax credit Credit for other dependents than four 0 0 dependents. see instructions 0 0 and check 0 0 note, E. El 0 8 Wages. salaries, tips, etc. Attach Form(s) W-2 8 Income 9a Taxable interest 9a Effectively Connected b Tax-exempt interest. Do not include on line 9a 19b I With U.S. 10a Ordinary dividends 10a Trade/ b Qualified dividends (see instructions) I10b I Business 11 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) . . 11 12 Scholarship and fellowship grants. Attach Form(s) 1042-S or required statement (see instructions) 12 13 Business income or (loss). Attach Schedule C or C-EZ (Form 1040) 13 14 Capital gain or (loss). Attach Schedule D (Form 1040) if required. If not required, check here 0 14 15 Other gains or (losses). Attach Form 4797 15 Attach Form(s) W-2, 1042-S, 16 Reserved 16 SSA-1042S, 17a IRAs. pensions, and annuities 117a I I 17b Taxable amount (see inst.) 17b RRB04ZS, and Ea88-A 18 Rental real estate, royalties, partnerships, trusts, etc. Attach Schedule E (Form 1040) . . 18 here. Also 19 Farm income or (loss). Attach Schedule F (Form 1040) 19 attach Fcwrit 1099-R if tax ) 20 Unemployment compensation 20 was withheld. 21 Other income. List type and amount (see instructions) 21 22 Total income exempt by a treaty from page 5. Schedule Of, Item L (1Xe) 122 I 23 Combine the amounts in the far right column for lines 8 through 21. This is your total effectively connected income IIP P3 24 Educator expenses (see instructions) 24 Adjusted 25 Health savings account deduction. Attach Form 8889 . . . 25 Gross 26 Moving expenses for members of the Armed Forces. Attach Income Form 3903 26 _ 27 Deductible part of self-employment tax. Attach Schedule SE (Form 1040) 27 28 Self-employed SEP, SIMPLE, and qualified plans . . . . 28 29 Self-employed health insurance deduction (see instructions) 29 30 Penalty on early withdrawal of savings 30 31 Scholarship and fellowship grants excluded 31 32 IRA deduction (see instructions) 32 33 Student loan interest deduction (see instructions) . . . 33 34 Add lines 24 through 33 34 35 Adjusted Gross Income. Subtract line 34 from line 23. Is' 35 36 Amount from line 35 (adjusted gross income) 36 Tax and 37 Itemized deductions from page 3, Schedule A, line 8 37 Credits 38 Qualified business income deduction (see instructions) 38 39 Exemptions for estates and trusts only (see instructions) 39 For Disclosure. Privacy Act, and Paperwork Reduction Act Notice. see instructions. Form 1040NR psis EFTA01222566 Form 1040NFt (20 8) Page 2 40 Add lines 37 through 39 40 Tax and 41 Taxable income. Subtract line 40 from line 36. If zero or less, enter -0- 41 Credits 42 Tax (see instr.). Check if any is from Form(s): a O 8814 bO 4972 c O 42 (continued) 43 Alternative minimum tax (see instructions). Attach Form 6251 43 44 Excess advance premium tax credit repayment. Attach Form 8962 44 45 Add lines 42, 43. and 44 IV. 45 46 Foreign tax credit. Attach Form 1116 if required 46 47 Credit for child and dependent care expenses. Attach Form 2441 47 48 Retirement savings contributions credit. Attach Form 8880 48 49 Child tax credit and credit for other dependents (see instructions) 49 50 Residential energy credit. Attach Form 5695 50 51 Other credits from Form: a 03B00 b • 8801 c O 51 52 Add lines 46 through 51. These are your total credits 52 53 Subtract line 52 from line 45. If zero or less. enter -0- Ili. 53 54 Tax on income not effectively connected with a U.S. trade or business from page 4, Other Schedule NEC, line 15 64 Taxes 55 Self-employment tax. Attach Schedule SE (Form 1040) 55 56 Unreported social security and Medicare tax from Form: a O 4137 b 08919 56 57 Additional tax on IRAs, other qualified retirement plans, etc. Attach Forrn 5329 if required 57 58 Transportation tax (see instructions) 58 59a Household employment taxes from Schedule H (Form 1040) 59a b Repayment of first-time homebuyer credit from Form 5405. Attach Form 5405 if required . 59b 60 Taxes from: a O Form 8959 b O Instructions; enter code(s) 60 61 Total tax. Add lines 53 through 60 ► 61 62 Federal income tax withheld from: Payments a Form(s) W-2 and 1099 62a b Form(s) 8805 62b e Form(s) 8288-A 62c d Form(s) 1042-S 62d 63 2018 estimated tax payments and amount applied 1101112017 return 63 64 Additional child tax credit. Attach Schedule 8812 . . . . 64 65 Net premium tax credit. Attach Form 8962 65 66 Amount paid with request for extension to file (see instructions) 66 67 Excess social security and tier 1 RRTA tax withheld (see instructions) 67 68 Credit for federal tax on fuels. Attach Form 4136 . . . . 68 69 Credits from Fcem:aO 2439 b O Reserved c O 8885 d O 69 70 Credit for amount paid with Form 1040-C 70 71 Add lines 62a through 70. These are your total payments IP. 71 72 If line 71 is more than line 61, subtract line 61 from line 71. This is the amount you overpaid 72 Refund 73a Amount of line 72 you want refunded to you. U Forrn 8888 is attached, check here . , O 73a Direct deposit? b Routing number I I IIP. c Type: O Cheeldnig O Savings See instructions. d Account number I I I I 1 e If you want your refund check mailed to an address outside the United States not shown on page 1. enter it here. 74 Amount of line 72 you want applied to your 2019 estimated tax P. 1 74 T Amount 75 Amount you owe. Subtract line 71 from line 61. For details on how to pay, see instructions DP 75 You Owe 76 Estimated tax penalty (see instructions) 1 76 I Third Party Do you want to allow another person to discuss this return with the IRS? See instructions • Yes. Complete below. • No Designee Phone Personal identification Designee's name lo no. a. number (PIN) 0. f Mi l Unde beser penaaltre iestrof nep:rry. I.da•Zanre thlettInhave raxam rannn ined nf this returnot anncel acconmpanying schedulesnnanaciil isntfant temenrintsn.naryl ttliodihe bestreorfnm az knowledge wind. Sign Here they Dec preparer based any Keep a copy of Vow signature Date Your occupation ii the United States If the IRS sent you an Identity this return for Protection PIN. enter it here (see instr.) your records. Mi l l i Pnnt/Type prepares name Preparer'a signature Date Paid Check El If PTIN Preparer self-employed Use Only Firm's name P. Firm's BN 10 , Firm's address P Phone no. Form 1040NR ooun EFTA01222567 Form 1040NR (20 i8) Page 3 Schedule A —Itemized Deductions (see instructions) 07 Taxes You Paid i State and local income taxes a State and local income taxes la b Enter the smaller of line la and $10.000 ($5.000 if married) lb Gifts 2 Gifts by cash or check. If you made any gift of $250 or more. to U.S. see instructions 2 Charities 3 Other than by cash or check. If you made any gift of $250 or more. see instructions. You must attach Form 8283 if the If you made a amount of your deduction is over $500 3 gift and received a benefit in 4 Carryover from prior year 4 retum. see instructions. 5 Add lines 2 through 4 5 Casualty 6 Casualty and theft loss(es) from a federally declared disaster (other than net qualified i t and Theft disaster losses). Attach Form 4684 and enter the amount from line 18 of that form. See Losses instructions 6 7 Other —from list in instructions. List type and amount PIP Other Itemized i ll Deductions 7 Total Itemized 8 Add the amounts in the far right column for lines 1b through 7. Also, enter this amount on Deductions Form 1040NR, line 37 8 Fcan 1040NR pole) EFTA01222568 Form 1040NR120019 Page 4 Schedule NEC —Tax on Income Not Effectively Connected With a U.S. Trade or Business (see instructions) Enter amount of Income under the appropriate rate of tax (see instructions) Nature of Income (d) Other (specify) (a) 10% (b) 15% (c) 30% % V 1 Dividends and dividend equivalents: a Dividends paid by U.S. corporations la b Dividends paid by foreign corporations lb c Dividend equivalent payments received with respect to section 871(m) transactions 1c 2 Interest: a Mortgage 2a b Paid by foreign corporations 2b c Other 2c 3 Industrial royalties (patents, trademarks, etc.) 3 4 Motion picture or T.V. copyright royalties 4 5 Other royalties (copyrights. recording. publishing. etc .) 5 6 Real property income and natural resources royalties 6 7 Pensions and annuities 7 8 Social security benefits 8 9 Capital gain from line 18 below 10 Gambling —Residents of Canada only. Enter net income in column (c). If zero or less, enter -0-. a Winnings b Losses 10c 11 Gambling winnings—Residents of counties other than Canada. Note: Losses not allowed 11 12 Other (specify) 10, ,—12 13 Add lines la through 12 in columns (a) through (d) 13 14 Multiply line 13 by rate of tax at top of each column 14 15 Tax on income not effectively connected with a U.S. trade or business. Add columns (a) through (d) of line 14. Enter the total here and on Form 1040NR. line 54 ► 15 Capital Gains and Losses From Sales or Exchanges of Property Enter only the capita gate and (f) LOSS (g) GAIN losses from property sales or 16 (a) Kind of property and description (b) Date (c) Date (e) Cost or other If (e) is more lf (d) 'smote exchanges that are from (if necessary. attach statement of acquired sold (d) Sales price basis than Kg. subtract (d) than (e). subtract (e) solaces within the United descriptive details not shown below) (mo.. day, yr.) (mo.. day. yr.) from (e) from (d) States and not effectively connected with a U.S. business. Do not include a gain or loss on disposing of a V.S. real property interest; report these gains and losses on Schedule D (Form 1040). Report property sales or exchanges that are effectively connected with a U.S. business on Schedule D (Form 1040). 17 Add columns (f) and (g) of line 16 17 roan 4797. or both. 18 Capital gain. Combine columns (f) and (q) of line 17. Enter the net gain here and on line 9 above (if a loss. enter -0-) P. Eli Form 1040NR pots) EFTA01222569 Form 1040NR (2018) Page 5 Schedule O1—Other Information (see instructions) Answer all questions A Of what country or countries were you a citizen or national during the tax year? B In what country did you claim residence for tax purposes during the tax year? C Have you ever applied to be a green card holder (lawful permanent resident) of the United States? ❑ Yes ❑ No D Were you ever: 1. A U.S. citizen? ❑ Yes ❑ No 2. A green card holder (lawful permanent resident) of the United States, ❑ Yes ❑ No If you answer "Yes" to (1) or (2), see Pub. 519, chapter 4, for expatriation rules that apply to you. E If you had a visa on the last day of the tax year, enter your visa type. If you did not have a visa, enter your U.S. immigration status on the last day of the tax year. F Have you ever changed your visa type (nonimmigrant status) or U.S. immigration status? ❑ Yes ❑ No If you answered "Yes," indicate the date and nature of the change. ► G List all dates you entered and left the United States during 2018. See instructions. Note: If you are a resident of Canada or Mexico AND commute to work in the United States at frequent intervals, check the box for Canada or Mexico and skip to item H ❑ Canada ❑ Mexico Date entered United States Date departed United States Date entered United States Date departed United States mmrdcVyy mm/dcVyy mmicid/yy mmicid/yy H Give number of days (including vacation, nonwodcdays, and partial days) you were present in the United States during: 2016 , 2017 ,and 2018 Did you file a U.S. income tax return for any prior year? ❑ Yes ❑ No If "Yes," give the latest year and form number you filed . . . ► J Are you filing a retum fora trust? ❑ Yes ❑ No If 'Yes," did the trust have a U.S. or foreign owner under the grantor trust rules, make a distribution or loan to a U.S. person, or receive a contribution from a U.S. person? ❑ Yes ❑ No K Did you receive total compensation of $250,000 or more during the tax year? ❑ Yes ❑ No If "Yes," did you use an alternative method to determine the source of this compensation? ❑ Yes ❑ No L Income Exempt from Tax —If you are claiming exemption from income tax under a U.S. income tax treaty with a foreign country, complete (1) through (3) below. See Pub. 901 for more information on tax treaties. 1. Enter the name of the country, the applicable tax treaty article, the number of months in prior years you claimed the treaty benefit, and the amount of exempt income in the columns below. Attach Form 8833 if required. See instructions. (b) Tax treaty (c) Number of months (d) Amount of exempt (a) Country article claimed In prior tax years Income In current tax year (e) Total. Enter this amount on Form 1040NR, line 22. Do not enter it on line 8 or line 12. . . ► 2. Were you subject to tax in a foreign country on any of the income shown in 1(d) above? ❑ Yes ❑ No 3. Are you claiming treaty benefits pursuant to a Competent Authority determination? ❑ Yes ❑ No If "Yes," attach a copy of the Competent Authority determination letter to your retum. M Check the applicable box it 1. This is the first year you are making an election to treat income from real property located in the United States as effectively connected with a U.S. trade or business under section 871k6. See instructions ►❑ 2. You have made an election in a previous year that has not been revoked, to treat income from real property located in the United States as effectively connected with a U.S. trade or business under section 871(d). See instructions ►❑ Form 1040NR pour) EFTA01222570