Form 8840 Closer Connection Exception Statement for Aliens

▶ Attach to Form 1040NR or Form 1040NR-EZ.

OMB No. 1545-0074

2010
For the year January 1—December 31, 2010, or other tax year Attachment
Department of the Treasury
Internal Revenue Service beginning , 2010, and ending , 20 . Sequence No. 101
Your first name and initial Last name Your U.S. taxpayer identification number, if any

Address in country of residence Address in the United States

Fill in your
addresses only if
you are filing this
form by itself and
not with your U.S.
tax return
Part I General Information

1 Type of U.S. visa (for example, F, J, M, etc.) and date you entered the United States ▶
2 Of what country or countries were you a citizen during the tax year?
3 What country or countries issued you a passport?
4 Enter your passport number(s) ▶
5 Enter the number of days you were present in the United States during:
2010 2009 2008 .
6 During 2010, 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)? . . . . . . . . . . . . . . . . . . . . . . . . Yes No
Part II Closer Connection to One Foreign Country

7 Where was your tax home during 2010?

8 Enter the name of the foreign country to which you had a closer connection than to the United States during 2010
▶
Next, complete Part IV on the back.
Part III Closer Connection to Two Foreign Countries

9 Where was your tax home on January 1, 2010?

10 After changing your tax home from its location on January 1, 2010, where was your tax home for the remainder of 2010?

11 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? . . . . . . . . . . Yes No
If “No,” attach an explanation.
12 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 2010 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
13 Have you filed or will you file tax returns for 2010 in the countries listed on lines 9 and 10? . . . . . . Yes No
If “Yes” to either line 12 or line 13, attach verification.
If “No” to either line 12 or line 13, please explain ▶

Next, complete Part IV on the back.

For Paperwork Reduction Act Notice, see page 4. Cat. No. 15829P Form 8840 (2010)
Form 8840 (2010) Page 2
Part IV Significant Contacts With Foreign Country or Countries in 2010

14 Where was your regular or principal permanent home located during 2010 (see instructions)?
15 If you had more than one permanent home available to you at all times during 2010, list the location of each and
explain ▶
16 Where was your family located?
17 Where was your automobile(s) located?
18 Where was your automobile(s) registered?

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

20 Where was the bank(s) with which you conducted your routine personal banking activities located?
a c
b d
21 Did you conduct business activities in a location other than your tax home? . . . . . . . . . . . Yes No
If “Yes,” where?
22a Where was your driver’s license issued?
b If you hold a second driver’s license, where was it issued?

23 Where were you registered to vote?

24 When completing official documents, forms, etc., what country do you list as your residence?
25 Have you ever completed:
a Form W-8 or Form W-8BEN (relating to foreign status)? . . . . . . . . . . . . . . . . . Yes No
b Form W-9, Request for Taxpayer Identification Number and Certification? . . . . . . . . . . . Yes No
c Form 1078, Certificate of Alien Claiming Residence in the United States? . . . . . . . . . . . . Yes No
d Any other U.S. official forms? If “Yes,” indicate the form(s) ▶ Yes No
26 In what country or countries did you keep your personal, financial, and legal documents?

27 From what country or countries did you derive the majority of your 2010 income?

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

If “Yes,” what type?
29 In what country or countries were your investments located (see instructions)?

30 Did you qualify for any type of “national” health plan sponsored by a foreign government? . . . . . . Yes No
If “Yes,” in what country?
If “No,” please explain ▶
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 30, attach a statement to this form.
Sign here 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
only if you are true, correct, and complete.
are filing
this form by
itself and
not with
your U.S.
▲

tax return Your signature Date

Form 8840 (2010)
Form 8840 (2010) Page 3

General Instructions However, you do not count the following

days of presence in the United States for
2. You changed your tax home during
2010 to a second foreign country.
Section references are to the U.S. purposes of the substantial presence 3. You continued to maintain your tax
Internal Revenue Code, unless otherwise test. home in the second foreign country for
specified. 1. Days you regularly commuted to the rest of 2010.
Purpose of Form work in the United States from a 4. You had a closer connection to
residence in Canada or Mexico. each foreign country than to the United
Use Form 8840 to claim the closer
2. Days you were in the United States States for the period during which you
connection to a foreign country(ies)
for less than 24 hours when you were maintained a tax home in that foreign
exception to the substantial presence
traveling between two places outside the country.
test. The exception is described later
United States. 5. You are subject to tax as a resident
and in Regulations section
301.7701(b)-2. 3. Days you were temporarily in the under the tax laws of either foreign
United States as a regular crew member country for all of 2010 or subject to tax
Note: You are not eligible for the closer
of a foreign vessel engaged in as a resident in both foreign countries for
connection exception if any of the
transportation between the United the period during which you maintained
following apply.
States and a foreign country or a a tax home in each foreign country.
• You were present in the United States possession of the United States unless
183 days or more in calendar year 2010. you otherwise engaged in trade or Tax Home
• You are a lawful permanent resident of business on such a day. Your tax home is your main place of
the United States (that is, you are a 4. Days you were unable to leave the business, employment, or post of duty
green card holder). United States because of a medical regardless of where you maintain your
condition or medical problem that arose family home. If you do not have a regular
• You have applied for, or taken other or main place of business because of the
affirmative steps to apply for, a green while you were in the United States.
nature of your work, then your tax home
card; or have an application pending to 5. Days you were an exempt is the place where you regularly live. If
change your status to that of a lawful individual. you do not fit either of these categories,
permanent resident of the United States. you are considered an itinerant and your
In general, an exempt individual is a
Even if you are not eligible for the (a) foreign government-related individual, tax home is wherever you work.
closer connection exception, you may (b) teacher or trainee, (c) student, or
qualify for nonresident status by reason (d) professional athlete competing in a Establishing a Closer Connection
of a treaty. See the instructions for line 6 charitable sports event. For more details, You will be considered to have a closer
for more details. see Pub. 519. connection to a foreign country than to
Note: If you qualify to exclude days of the United States if you or the IRS
Who Must File establishes that you have maintained
presence in the United States because
If you are an alien individual and you you were an exempt individual (other more significant contacts with the
meet the closer connection exception to than a foreign government-related foreign country than with the United
the substantial presence test, you must individual) or because of a medical States.
file Form 8840 with the IRS to establish condition or medical problem (see item 4 Your answers to the questions in Part
your claim that you are a nonresident of above), you must file Form 8843, IV will help establish the jurisdiction to
the United States by reason of that Statement for Exempt Individuals and which you have a closer connection.
exception. Individuals With a Medical Condition.
For more details on the substantial When and Where To File
presence test and the closer connection Closer Connection Exception If you are filing a 2010 Form 1040NR or
exception, see Pub. 519, U.S. Tax Guide Even though you would otherwise meet Form 1040NR-EZ, attach Form 8840 to
for Aliens. the substantial presence test, you will it. Mail your tax return by the due date
Note: You can download forms and not be treated as a U.S. resident for (including extensions) to the address
publications at IRS.gov. 2010 if: shown in your tax return instructions.
• You were present in the United States If you do not have to file a 2010 tax
Substantial Presence Test for fewer than 183 days during 2010, return, mail Form 8840 to the
You are considered a U.S. resident if you • You establish that during 2010, you Department of the Treasury, Internal
meet the substantial presence test for had a tax home in a foreign country, and Revenue Service Center, Austin, TX
2010. You meet this test if you were 73301-0215 by the due date (including
physically present in the United States • You establish that during 2010, you extensions) for filing Form 1040NR or
for at least: had a closer connection to one foreign Form 1040NR-EZ.
country in which you had a tax home
• 31 days during 2010 and than to the United States, unless you
• 183 days during the period 2010, 2009, had a closer connection to two foreign
and 2008, counting all the days of countries.
physical presence in 2010 but only 1/3 Closer Connection to Two Foreign
the number of days of presence in 2009
and only 1/6 the number of days in 2008. Countries
Days of presence in the United States. You may demonstrate that you have a
Generally, you are treated as being closer connection to two foreign
present in the United States on any day countries (but not more than two) if all
that you are physically present in the five of the following apply.
country at any time during the day. 1. You maintained a tax home as of
January 1, 2010, in one foreign country.
Form 8840 (2010) Page 4

Penalty for Not Filing Form Line 14 You are not required to provide the
information requested on a form that is
8840 A “permanent home” is a dwelling unit subject to the Paperwork Reduction Act
If you do not timely file Form 8840, you (whether owned or rented, and whether unless the form displays a valid OMB
will not be eligible to claim the closer a house, an apartment, or a furnished control number. Books or records
connection exception and may be room) that is available at all times, relating to a form or its instructions must
treated as a U.S. resident. continuously and not solely for short be retained as long as their contents
stays. may become material in the
You will not be penalized if you can
administration of any Internal Revenue
show by clear and convincing evidence Line 29 law. Generally, tax returns and return
that you took reasonable actions to
information are confidential, as required
become aware of the filing requirements For stocks and bonds, indicate the
by section 6103.
and significant steps to comply with country of origin of the stock company
those requirements. or debtor. For example, if you own The average time and expenses
shares of a U.S. publicly traded required to complete and file this form
Specific Instructions corporation, the investment is will vary depending on individual
considered located in the United States, circumstances. For the estimated
Line 6 even though the shares of stock are averages, see the instructions for your
stored in a safe deposit box in a foreign income tax return.
If you checked the “Yes” box on line 6,
country.
do not file Form 8840. You are not If you have suggestions for making
eligible for the closer connection this form simpler, we would be happy to
exception. However, you may qualify for Paperwork Reduction Act Notice. We hear from you. See the instructions for
nonresident status by reason of a treaty. ask for the information on this form to your income tax return.
See Pub. 519 for details. If so, file Form carry out the Internal Revenue laws of
8833, Treaty-Based Return Position the United States. Section 7701(b) and
Disclosure Under Section 6114 or its regulations require that you give us
7701(b), with your Form 1040NR or Form the information. We need it to determine
1040NR-EZ. if you meet the closer connection
exception to the substantial presence
test.