EFTA01222561.pdf

F0.1NONR U.S. Nonresident Alien Income Tax Return Ili Go to www.irs.gov/Form1040NR for instructions and the latest information. OMB No. 154S-0074 Department of the Treasury Internal Revenue Service begnning For the year January 1-December . 2017. and ending 31. 2017. or other tax year .20 01 7 Your first ame and initial Last name Identifying number (see Instructions) Present home address (number. street. and apt. no.. or rural route). If you have a box see instructions. Check it O Individual M. Please print O Estate or That or type City, town or post office. state. and ZIP code. If you have a foreign address. also complete spaces below. See instructions. Foreign county name Foreign promise/state/county Foreign postal code Filing 1 0 Single resident of Canada or Mexico or single U.S. national 4 M Married resident of South Korea Status 2 0 Other single nonresident alien 5 • Other married nonresident alien 3 0 Married resident of Canada or Mexico or monied U.S. national 6 M Qualifying widow(er) (see instructions) Check onty If you checked box 3 or 4 above, enter the information below. Child's name O. one box. (I) Spouse's first name and initial 00 Spouse's last name (IV) Spouse's identifying number Exemptions 7a 0 Yourself. If someone can claim you as a dependent, do not check box 7a . . . . Boxes checked b 0 Spouse. Check box 7b only if you checked box 3 or 4 above and your spouse did not on 7a and lb have any U.S. gross income No. of children on 7c who: c Dependents: (see Instructions) (2) Dependent's (3) Dependent's RV if qualifying . lived with you identifying number relationship to you child for child tax If more (1) Frst name Last name credit (see Instr.) • did not live with than lour 0 you due to divorce dependents. or separation (see 0 instructions) see instructions 0 Dependents on 7c 0 not entered above Add numbers on d Total number of exemptions claimed lines above Po 8 Wages, salaries, tips. etc. Attach Form(s) W-2 .I 8 Income 9a Taxable interest 1 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) 110D I a 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 • 14 15 Other gains or (losses). Attach Form 4797 15 Attach Form(s) w-2, 1042-S, 16a IRA distributions . . 16a 16b Taxable amount (see instructions) 16b SSA-1042S, 17a Pensions and annuities 17a 17b Taxable amount (see instructions) 17b RRB-10425, and 8288-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 Form(s) 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 01Item L (1)(e) 122 1 23 Combine the amounts in the far right column for lines 8 through 21. This is your total effectively connected income Il. 23 24 Educator expenses (see instructions) 24 I Adjusted 25 Health savings account deduction. Attach Form 8889 . . . 25 Gross 26 Moving expenses. Attach Form 3903 26 Income 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 Domestic production activities deduction. Attach Form 8903 34 35 Add lines 24 through 34 35 36 Subtract line 35 from line 23. This is your adjusted gross income Iii 36 For Disclosure. Privacy Act, and Paperwork Reduction Act Notice, see instructions. Form 1040NR r2017; EFTA01222561 Form 1040NR (20 7) Page 2 37 Amount from line 36 (adjusted gross income) 37 Tax and 38 Itemized deductions from page 3, Schedule A, line 15 38 Credits 39 Subtract line 38 from line 37 39 40 Exemptions (see instructions) 40 41 Taxable income. Subtract line 40 from line 39. If line 40 is more than line 39, enter -0- . 41 42 Tax (see inst.). Check if any is from Form(s): a O8814 bO 4972 42 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 lir. 45 46 Foreign tax credit. Attach Font, 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. Attach Schedule 8812, if required . . . . 49 50 Residential energy credit. Attach Form 5695 50 51 Other credits from Form: a O 3800 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 line 52 is more than line 45. enter -0- P. 53 54 Tax on income not effectively connected with a U.S. trade or business from page 4. Schedule NEC, line 15 54 Other 55 Self-employment tax. Attach Schedule SE (Form 1040) 55 Taxes 56 Unreported social security and Medicare tax from Form: a O 4137 b • 8919 56 57 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 57 58 Transportation tax (see instructions) 58 59a Household employment taxes from Schedule II (Form 1040) 59a b First-time homebuyer credit repayment. Attach Form 5405 if required 59b 60 Taxes from: a O Form 8959 b O Instructions; enter code(s) 60 61 Add lines 53 through 60. This is your total tax e. 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 2017 estimated tax payments and amount applied from 2016 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 RATA tax withheld (see instructions) 67 68 Credit for federal tax paid on fuels. Attach Form 4136 . . . 68 69 Credits from Forma • 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 Ilr. 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 ou. If Form 8888 is attached, check here . a. O 73a Direct deposit? b Routing number I 1 PP c Type: O Checkir O Savings See instructions. d Account number I I I e If you want your refund check maied to an address outside the Linked States not shown on page 1, enter it here. 74 Amount of line 72 you want applied to your 2018 estimated tax Do 1 74 T Amount 75 Amount you owe. Subtract line 71 from line 61. For details on how to pay, see instructions IP 75 You Owe 76 Estimated tax penalty (see instructions) I 76 I Third Party Do you want to allow another person to discuss this return with the IRS? See instructions O Yes. Complete below. • No Designee Phone Personal identification Designee's name s. no. 0. number (PIN) pi I I I I I Unde beeer. penaaltireesvof net.321y. I.dnencellanre thlteIlehaye examined at Onn)this return and accom n panying) T.:hedu baselden s nanacj isntiiinttemenls.nr: ilttnodihe best nreorfnm az knowledge and n Sign Here they Dec preparer any Keep a copy of Your signature Date Vow occupation ri the United States If the IRS sent you an Identity this return for Protection PIN. enter it here (see instr.) your records. 1 1 1 1 1 1 1 Printaype preparets name Preparers signature Date Paid Check O If PTIN self-employed Preparer u se o n ly Firm's name a FIrm's BN a. Firm's address s. Phone no. rorm1040NR (2017) EFTA01222562 Form 1040NR (2017) Page 3 Schedule A —Itemized Deductions (see instructions) 07 Taxes You Paid i State and local income taxes 1 Caution: If you made a gift and received a benefit in Gifts return, see instructions. to U.S. 2 Gifts by cash or check. If you made any gift of $250 or more. Charities see instructions 2 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 amount of your deduction is over $500 3 4 Carryover from prior year 4 5 Add lines 2 through 4 5 Casualty and Theft Losses 6 Casualty or theft loss(es). Attach Form 4684. See instructions 6 Job 7 Unreimbursed employee expenses —job travel. union dues. Expenses job education. etc. You must attach Form 2106 or Form and Certain 2106-EZ if required. See instructions PP Miscellaneous 7 Deductions 8 Tax preparation fees 8 9 Other expenses. See instructions for expenses to deduct here. List type and amount P. 9 10 Add lines 7 through 9 10 11 Enter the amount from Form 1040NR. line 37 [ 11 I 12 Multiply line 11 by 2% (0.02) 12 13 Subtract line 12 from line 10. If line 12 is more than line 10. enter -0- 13 14 Other —see instructions for expenses to deduct here. List type and amount DP Other Miscellaneous Deductions 14 15 Is Form 1040NR. line 37, over the amount shown below for the filing status box you Total checked on page 1 of Form 1040NR: Itemized Deductions • $313.800 if you checked box 6; • $261.500 if you checked box 1 or 2; or • $156.900 if you checked box 3, 4. or 5? 0 No. Your deduction is not limited. Add the amounts in the far right column for lines 1 through 14. Also enter this amount on Form 1040NR. line 38. 0 Yes. Your deduction may be limited. See the Itemized Deductions Worksheet in the instructions to figure the amount to enter here and on Form 1040NR. line 38. 15 Fam 1040NR (2017) EFTA01222563 Font, 1040NR (2017) 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% (W15% (c) 30% 1 Dividends paid by: a U.S. corporations 1a b Foreign corporations lb 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 9 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 countries other than Canada. Note: Losses not allowed 11 12 Other (specify)► 12 13 Add lines 1a 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 capital gains and (0 LOSS (g) (MIN losses front property sales at 16 (a) Kind of property and description (b) Date (c) Date (e) Cost or other If (e) is more If (d) is more exchanges that are from (if necessary. attach statement of acquired sold (4 Sales price basis than (d). subtract (d) descriptive details not shown below) (mo.. day. yr.) (mo.. day, yr.) than (e). subtract (e) gamete within the United from (a) States and not effectively from (d) connected with a U.S. business. Do not include a gain or loss on disposing of a U.S. real property interest: report these gains and losses on Schedule I) (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 16 117 Form 4797. or both. 18 Capital gain. Combine columns (0 and (g) of line 17. Enter the net gain here and on line 9 above Of a loss, enter -0-) ► 1 18 Form 1040NR (2017) EFTA01222564 Form 1040NR (2017) 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. ► List all dates you entered and left the United States during 2017. 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 mmicid/yy mmicid/yy mmiddiyy mmiddiyy H Give number of days (including vacation, nonworkdays, and partial days) you were present in the United States during: 2015 , 2016 ,and 2017 I 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 return for a 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 6250,000 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 numbs 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 return. Forrri1040NR (2017) EFTA01222565