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Sam 2555-EZ Foreign Earned Income Exclusion OMB No. 1545.0074
Department of the Treasury
P Attach to Form 1040. Complete the Foreign Earned Income Tax Worksheet in the
Instructions for Form 1040 if you enter an amount on line 18. 2017
Attachment
Internal Revenue Servce (99) P Go to www.irs.gov/Form2555EZ for instructions and the latest information. Sequence No. 34A
Name shown on Form 1040 Your social security number
I
• Are a U.S. citizen or a resident alien. • Don't have self-employment income.
You May Use • Earned wages/salaries in a foreign country.
This Form • Had total foreign earned income And You • Don't have business/moving expenses.
If You: of $102,100 or less. See line 17. : • Don't claim the foreign housing
exclusion or deduction.
• Are filing a calendar year return that covers
a 12-month period.
Part I Tests To See If You Can Take the Foreign Earned Income Exclusion
1 Bona Fide Residence Test
a Were you a bona fide resident of a foreign country or countries for a period that includes an entire tax year
(see instructions)? ❑ Yes O No
• If you answered "Yes." you meet this test. Fill in line 1b and then go to line 3.
• If you answered "No," you don't meet this test. Go to line 2 to see if you meet the Physical Presence Test.
b Enter the date your bona fide residence began IP. . and ended (see instructions)►
2 Physical Presence Test
a Were you physically present in a foreign country or countries for at least 330 full days during —
I 2017 or ❑ Yes 0 No
l any other period of 12 months in a row starting or ending in 2017?
• If you answered "Yes." you meet this test. Fill in line 2b and then go to line 3.
• If you answered "No," you don't meet this test. You can't take the exclusion unless you meet the Bona
Fide Residence Test above.
b The physical presence test is based on the 12-month period from P. through ►
3 Tax Home Test. Was your tax home in a foreign country or countries throughout your period of bona fide
residence or physical presence, whichever applies? ❑ Yes O No
• If you answered "Yes." you can take the exclusion. Complete Part II below and then go to page 2.
• If you answered "No," you can't take the exclusion. Don't file this form.
Part II General Information
4 Your foreign address (including country) 5 Your occupation
6 Employer's name 7 Employer's U.S. address (including ZIP code) 8 Employer's foreign address
9 Employer is (check any that apply):
a A U.S. business
b A foreign business
c Other (specify) ►
10a If you previously filed Form 2555 or 2555-EZ. enter the last year you filed the form. IP.
b If you didn't previously file Form 2555 or 2555-EZ. check here I" O and go to line 11a.
c Have you ever revoked the foreign earned income exclusion? ❑ Yes ❑ No
d If you answered "Yes." enter the tax year for which the revocation was effective. IP.
11a List your tax home(s) during 2017 and date(s) established. ►
b Of what country are you a citizen/national? P.
For Paperwork Reduction Act Notice, see the Form 1040 instructions. Form 2555-EZ (2017)
EFTA01222648
Form 2555•EZ(2017) Page 2
Partlll Days Present in the United States— Complete this part if you were in the
United States or its possessions during 2017.
(e) Number of days (d) Income earned in U.S.
12 (a) Date arrived In U.S. (b) Date left U.S.
In U.S. on business on business (attach computation)
Part IV Figure Your Foreign Earned Income Exclusion
13 Maximum foreign earned income exclusion 13 i $102,100 00
14 Enter the number of days in your qualifying period that fall within 2017 days
15 Did you enter 365 on line 14?
❑ Yes. Enter "1.000."
❑ No. Divide line 14 by 365 and enter the result as 16
a decimal (rounded to at least three places).
16 Multiply line 13 by line 15 6
17 Enter, in U.S. dollars. the total foreign earned income you earned and received in 2017 (see
instructions). Be sure to include this amount on Form 1040. line 7 17
Caution: If the amount on line 17 is more than $102,100. don't file this form. You must file Form
2555 instead.
18 Foreign earned income exclusion. Enter the smaller of line 16 or line 17 here and in parentheses
on Form 1040, line 21. Next to the amount enter "2555-EZ." On Form 1040, subtract this amount
from your income to arrive at total income on Form 1040. line 22 ► 18
Form 2555-EZ (201a
EFTA01222649
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