U.S. Income Tax Return for Certain Nonresident Aliens With No Dependents

Transcription

1 Form 1040NR-EZ U.S. Income ax Return for Certain Nonresident liens With No Dependents MB No Department of the reasury Internal Revenue Service Go to for instructions and the latest information. Your first name and initial Last name Identifying number (see instructions) Please print or type. See separate instructions. Filing Status Check only one box. ttach Form(s) W-2 or 1042-S here. lso attach Form(s) 1099-R if tax was withheld. Refund Direct deposit? See instructions. mount You we hird Party Designee Sign Here Keep a copy of this return for your records. Paid Preparer Use nly DEV PEL Present home address (number, street, and apt. no., or rural route). If you have a P.. box, see instructions. 25 S 10H S City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below. See instructions. SN JSE, C Foreign country name Foreign province/state/county Foreign postal code US 1 Single nonresident alien 2 Married nonresident alien 3 Wages, salaries, tips, etc. ttach Form(s) W axable refunds, credits, or offsets of state and local income taxes Scholarship and fellowship grants. ttach Form(s) 1042-S or required statement otal income exempt by a treaty from page 2, Item J(1)(e). 6 7 dd lines 3, 4, and Scholarship and fellowship grants excluded Student loan interest deduction Subtract the sum of line 8 and line 9 from line 7. his is your adjusted gross income Itemized deductions (see instructions).. (Standard... Deduction.... llowed.. Under Subtract line 11 from line U.S.-India Income ax reaty) Exemption (see instructions) axable income. Subtract line 13 from line 12. If line 13 is more than line 12, enter ax. Find your tax in the tax table in the instructions Unreported social security and Medicare tax from Form: a 4137 b dd lines 15 and 16. his is your total tax a Federal income tax withheld from Form(s) W-2 and 1099-R 18a 3 b Federal income tax withheld from Form(s) 1042-S... 18b estimated tax payments and amount applied from 2016 return Credit for amount paid with Form 1040-C dd lines 18a through 20. hese are your total payments If line 21 is more than line 17, subtract line 17 from line 21. his is the amount you overpaid 22 23a mount of line 22 you want refunded to you. If Form 8888 is attached, check here 23a b Routing number c ype: Checking Savings d ccount number e If you want your refund check mailed to an address outside the United States not shown above, enter that address here: 24 mount of line 22 you want applied to your 2018 estimated tax mount you owe. Subtract line 21 from line 17. For details on how to pay, see instructions Estimated tax penalty (see instructions) Do you want to allow another person to discuss this return with the IRS? See instructions. Yes. Complete the following. No Designee s name Phone no. Personal identification number (PIN) Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and accurately list all amounts and sources of U.S. source income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your signature Date 01/24/18 Your occupation in the United States SUDEN If the IRS sent you an Identity Protection PIN, enter it here (see inst.) Print/ype preparer s name Preparer s signature Date Check if PIN self-employed Firm s name PRCICE LB Firm s address /24/18 S Firm s EIN - 15 PRCICE LB WY WSHINGN DC 205 Phone no For Disclosure, Privacy ct, and Paperwork Reduction ct Notice, see instructions. Form 1040NR-EZ (2017) QN

2 PEL Form 1040NR-EZ (2017) Page 2 Schedule I ther Information (see instructions) nswer all questions B f what country or countries were you a citizen or national during the tax year? In what country did you claim residence for tax purposes during the tax year? INDI INDI C Have you ever applied to be a green card holder (lawful permanent resident) of the United States?.... Yes No D E Were you ever: 1. U.S. citizen? Yes No 2. 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 may apply to you. 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. F1 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 See instructions. Note: If you are a resident of Canada or Mexico ND 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 mm/dd/yy Date departed United States mm/dd/yy 02/01/ /24/2017 Date entered United States mm/dd/yy Date departed United States mm/dd/yy H Give number of days (including vacation, non-workdays, and partial days) you were present in the United States during: 2015, 2016, and 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 NR J Income Exempt from ax 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. ttach Form 8833 if required. See instructions. (b) ax treaty (c) Number of months (a) Country article claimed in prior tax years INDI 21(2) 5 (d) mount of exempt income in current tax year (e) otal. Enter this amount on Form 1040NR-EZ, line 6. Do not enter it on line 3 or line Were you subject to tax in a foreign country on any of the income shown in 1(d) above?..... Yes No 3. re you claiming treaty benefits pursuant to a Competent uthority determination? Yes No If Yes, attach a copy of the Competent uthority determination letter to your return. QN Form 1040NR-EZ (2017)

3 Form 8843 Statement for Exempt Individuals and Individuals With a Medical Condition For use by alien individuals only. MB No Go to for the latest information. Department of the reasury For the year January 1 December 31, 2017, or other tax year ttachment Sequence No. 102 Internal Revenue Service beginning, 2017, and ending, 20. Your first name and initial Last name Your U.S. taxpayer identification number, if any DEV PEL Fill in your addresses only if you are filing this form by itself and not with your tax return ddress in country of residence ddress in the United States Part I General Information 1a ype of U.S. visa (for example, F, J, M, Q, etc.) and date you entered the United States b Current nonimmigrant status. If your status has changed, also enter date of change and previous status. See instructions. F-1 INDI F1 08/01/ f what country or countries were you a citizen during the tax year? 3a What country or countries issued you a passport? INDI b Enter your passport number(s) B a Enter the actual number of days you were present in the United States during: b Enter the number of days in 2017 you claim you can exclude for purposes of the substantial presence test 327 Part II eachers and rainees 5 For teachers, enter the name, address, and telephone number of the academic institution where you taught in For trainees, enter the name, address, and telephone number of the director of the academic or other specialized program you participated in during Enter the type of U.S. visa (J or Q) you held during: If the type of visa you held during any of these years changed, attach a statement showing the new visa type and the date it was acquired. 8 Were you present in the United States as a teacher, trainee, or student for any part of 2 of the 6 prior calendar years (2011 through 2016)? Yes No If you checked the Yes box on line 8, you cannot exclude days of presence as a teacher or trainee unless you meet the Exception explained in the instructions. Part III Students 9 Enter the name, address, and telephone number of the academic institution you attended during 2017 SN JSE SE UNIVERSIY NE WSHINGN SQURE, SN JSE, C, Enter the name, address, and telephone number of the director of the academic or other specialized program you participated in during 2017 DN HRKEY NE WSHINGN SQURE, SN JSE, C, Enter the type of U.S. visa (F, J, M, or Q) you held during: F-1. If the type of visa you held during any of these years changed, attach a statement showing the new visa type and the date it was acquired. 12 Were you present in the United States as a teacher, trainee, or student for any part of more than 5 calendar years? Yes No If you checked the Yes box on line 12, you must provide sufficient facts on an attached statement to establish that you do not intend to reside permanently in the United States. 13 During 2017, 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? Yes No 14 If you checked the Yes box on line 13, explain For Paperwork Reduction ct Notice, see instructions. Form 8843 (2017) QN

4 Form 8843 (2017) Page 2 Part IV Professional thletes 15 Enter the name of the charitable sports event(s) in the United States in which you competed during 2017 and the dates of competition 16 Enter the name(s) and employer identification number(s) of the charitable organization(s) that benefited from the sports event(s) Note: You must attach a statement to verify that all of the net proceeds of the sports event(s) were contributed to the charitable organization(s) listed on line 16. Part V Individuals With a Medical Condition or Medical Problem 17a Describe the medical condition or medical problem that prevented you from leaving the United States b Enter the date you intended to leave the United States prior to the onset of the medical condition or medical problem described on line 17a c Enter the date you actually left the United States 18 Physician s Statement: I certify that Name of taxpayer was unable to leave the United States on the date shown on line 17b because of the medical condition or medical problem described on line 17a and there was no indication that his or her condition or problem was preexisting. Name of physician or other medical official Physician s or other medical official s address and telephone number Sign here only if you are filing this form by itself and not with your tax return QN Physician s or other medical official s signature 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. Your signature Date Date Form 8843 (2017)

5 BLE YER 2017 California Nonresident or Part-Year Resident Income ax Return Long Form CH FEDERL REURN PE 17 PB DEV PEL 25 S 10H S SN JSE C FRM 540NR R RP Filing Exemptions otal axable Income x 2 Married/RDP filing jointly. See inst. 5 Qualifying widow(er) with dependent child. Enter year spouse/rdp died 3 Married/RDP filing separately. Enter spouse s/rdp s SSN or IIN above and full name here If your California filing status is different from your federal filing status, check the box here... Status 1 Single 4 Head of household (with qualifying person). See instructions. 6 If someone can claim you (or your spouse/rdp) as a dependent, check the box here. See inst For line 7, line 8, line 9, and line 10: Multiply the amount you enter in the box by the pre-printed dollar amount for that line. Whole dollars only 7 Personal: If you checked box 1, 3, or 4 above, enter 1 in the box. If you checked box 2 or 5, enter 2. If you checked the box on line 6, see instructions $114 = $ Blind: If you (or your spouse/rdp) are visually impaired, enter 1; if both are visually impaired, enter $114 = $ 9 Senior: If you (or your spouse/rdp) are 65 or older, enter 1; if both are 65 or older, enter 2. 9 $114 = $ 10 Dependents: Do not include yourself or your spouse/rdp. First Name Last Name SSN Dependent's relationship to you D N M I L Dependent 1 Dependent 2 Dependent 3 otal dependent exemptions $353 = $ 11 Exemption amount: dd line 7 through line $ otal California wages from your Form(s) W-2, box Enter federal GI from Form 1040, line 37; 1040, line 21; 1040EZ, line 4; 1040NR, line 36; or 1040NR-EZ, line California adjustments subtractions. Enter the amount from Schedule C (540NR), line 37, column B Subtract line 14 from line 13. If less than zero, enter the result in parentheses. See instructions California adjustments additions. Enter the amount from Schedule C (540NR), line 37, column C djusted gross income from all sources. Combine line 15 and line Enter the larger of: Your California itemized deductions from Schedule C (540NR), line 44; R Your California standard deduction. See instructions Subtract line 18 from line 17. his is your total taxable income. If less than zero, enter Long Form 540NR 2017 Side 1

6 Your name: Your DEV PEL SSN or IIN: C axable Income Special Credits Payments ther axes verpaid ax/ax Due ax. Check the box if from: x ax able ax Rate Schedule FB 38 FB C adjusted gross income from Schedule C (540NR), Part IV, line C axable Income from Schedule C (540NR), Part IV, line C ax Rate. Divide line 31 by line C ax Before Exemption Credits. Multiply line 35 by line C Exemption Credit Percentage. Divide line 35 by line 19. If more than 1, enter C Prorated Exemption Credits. Multiply line 11 by line 38. If the amount on line 13 is more than $187,203, see instructions C Regular ax Before Credits. Subtract line 39 from line 37. If less than zero, enter D 41 ax. See instructions. Check the box if from: Schedule G-1 FB dd line 40 and line Nonrefundable Child and Dependent Care Expenses Credit. See instructions. ttach form FB Credit for joint custody head of household. See instructions Credit for dependent parent. See instructions Credit for senior head of household. See instructions Credit percentage. Enter the amount from line 38 here. N If more than 1, enter 1.. See instructions Credit amount. See instructions Enter credit name code and amount Enter credit name code and amount o claim more than two credits. See instructions Nonrefundable renter s credit. See instructions dd line 50 and line 55 through 61. hese are your total credits Subtract line 62 from line 42. If less than zero, enter M 71 lternative minimum tax. ttach Schedule P (540NR) Mental Health Services ax. See instructions ther taxes and credit recapture. See instructions.... I dd line 63, line 71, line 72, and line 73. his is your total tax L 81 California income tax withheld. See instructions C estimated tax and other payments. See instructions Withholding (Form 592-B and/or 593). See instructions Excess SDI (or VPDI) withheld. See instructions Earned Income ax Credit (EIC) dd lines 81 through 85. hese are your total payments. See instructions verpaid tax. If line 86 is more than line 74, subtract line 74 from line mount of line 101 you want applied to your 2018 estimated tax verpaid tax available this year. Subtract line 102 from line ax due. If line 86 is less than line 74, subtract line 86 from line Side 2 Long Form 540NR

7 DEV PEL Your name: Your SSN or IIN: Code mount Contributions California Seniors Special Fund. See instructions... lzheimer s Disease/Related Disorders Fund.... Rare and Endangered Species Preservation Voluntary ax Contribution Program.... California Breast Cancer Research Voluntary ax Contribution Fund.... D California Firefighters Memorial Fund.... Emergency Food for Families Voluntary ax Contribution Fund.... California Peace fficer Memorial Foundation Fund.... California Sea tter Fund.... N California Cancer Research Voluntary ax Contribution Fund School Supplies for Homeless Children Fund... State Parks Protection Fund/Parks Pass Purchase Protect ur Coast and ceans Voluntary ax Contribution Fund... Keep rts in Schools Voluntary ax Contribution Fund.... M I L State Children s rust Fund for the Prevention of Child buse.... Prevention of nimal Homelessness and Cruelty Fund.... Revive the Salton Sea Fund.... California Domestic Violence Victims Fund.... Special lympics Fund.... ype 1 Diabetes Research Fund.... California YMC Youth and Government Voluntary ax Contribution Fund.... Habitat for Humanity Voluntary ax Contribution Fund.... California Senior Citizen dvocacy Voluntary ax Contribution Fund.... Native California Wildlife Rehabilitation Voluntary ax Contribution Fund.... Rape Backlog Kit Voluntary ax Contribution Fund.... dd code 4 through code 440. his is your total contribution Long Form 540NR 2017 Side 3

8 Your name: Your DEV PEL SSN or IIN: mount You we Interest and Penalties Refund and Direct Deposit 121 MUN YU WE. dd line 104 and line. See instructions. Do not send cash. Mail to: FRNCHISE BRD, P B , SCRMEN C Pay nline Go to ftb.ca.gov/pay for more information. 122 Interest, late return penalties, and late payment penalties Underpayment of estimated tax. Check the box: FB 5805 attached FB 5805F attached otal amount due. See instructions. Enclose, but do not staple, any payment REFUND R N MUN DUE. Subtract line from line 103. Mail to: FRNCHISE BRD, P B , SCRMEN C Fill in the information to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or a deposit slip. See instructions. Have you verified the routing and account numbers? Use whole dollars only. ll or the following amount of my refund (line 125) is authorized for direct deposit into the account shown below: Checking Savings Routing number ype ccount number 126 Direct deposit amount he remaining amount of my refund (line 125) is authorized for direct deposit into the account shown below: Checking Savings Routing number ype ccount number 127 Direct deposit amount IMPRN: ttach a copy of your complete federal return. o learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information, go to ftb.ca.gov/forms and search for o request this notice by mail, call Under penalties of perjury, I declare that I have examined this tax return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Your signature Date Spouse s/rdp s signature (if a joint tax return, both must sign) Sign Here It is unlawful to forge a spouse s/rdp s signature. Joint tax return? (See instructions) Your address. Enter only one address. devpatel@gmail.com Preferred phone number Paid preparer s signature (declaration of preparer is based on all information of which preparer has any knowledge) Firm s name (or yours, if self-employed) PRCICE LB Firm s address 15 PRCICE LB WY WSHINGN DC 205 D N M I L 01/24/ PIN FEIN Do you want to allow another person to discuss this tax return with us? See instructions.... Yes No Print hird Party Designee s Name elephone Number S x Side 4 Long Form 540NR

9 BLE YER 2016 California djustments Nonresidents or Part-Year Residents Important: ttach this schedule behind Long Form 540NR, Side 4 as a supporting California schedule. Name(s) as shown on tax return SSN or IIN SCHEDULE C (540NR) DEV PEL Part I Residency Information. Complete all lines that apply to you and your spouse/rdp for taxable year During 2016: 1 My California (C) Residency (Check one) a Myself: Nonresident Part-Year Resident Resident b Spouse: Nonresident Part-Year Resident Resident Yourself Spouse/RDP 2 a I was domiciled in (enter two letter code, see instructions)... F C b I was in the military and stationed in (enter two letter code)... 3 I became a C resident (enter state of prior residence and date (mm/dd/yyyy) of move)... / / / / 4 I became a C nonresident (enter new state of residence and date (mm/dd/yyyy) of move). / / / / 5 I was a C nonresident the entire year (enter state of residence)... F C 6 he number of days I spent in C for any purpose was:... D I owned a home/property in C (enter Y for Yes, N for No)... N 8 Before 2016: I was a C resident for the period of... / / / / / / / / Part II Income djustment Schedule B C D E Section Income Federal mounts (taxable amounts from your federal tax return) Subtractions See instructions (difference between C & federal law) dditions See instructions (difference between C & federal law) otal mounts Using C Law s If You Were a C Resident (subtract col. B from col. ; add col. C to the result) C mounts (income earned or received as a C resident and income earned or received from C sources as a nonresident) 7 Wages, salaries, tips, etc. See instructions before making an entry in col. B or C axable interest. (b)...8(a) 9 rdinary dividends. See instructions. (b)...9(a) 10 axable refunds, credits, or offsets of state and local income taxes limony received. See instructions Business income or (loss)...12 M 13 Capital gain or (loss). See instructions ther gains or (losses) IR distributions. See instructions. (a)...15(b) 16 Pensions and annuities. See instructions. I (a)...16(b) 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc...17 L 18 Farm income or (loss) Unemployment compensation Social security benefits. (a) 20(b) 21 ther income. { a California lottery winnings a a b Disaster loss deduction from FB 3805V b b c Federal NL (Form 1040, line 21) c c d NL deduction from FB 3805V 21 d d e NL from FB 3805D, FB 3805Z, FB 3806, FB 3807, or FB 3809 e e f ther (describe): f f 22 a otal: Combine line 7 through line 21 in each column. Continue to Side a N For Privacy Notice, get FB 1131 ENG/SP Schedule C (540NR) 2016 Side 1

10 Income djustment Schedule B C D E Section B djustments to Income Federal mounts (taxable amounts from your federal tax return) Subtractions See instructions (difference between C & federal law) dditions See instructions (difference between C & federal law) otal mounts Using C Law s If You Were a C Resident (subtract col. B from col. ; add col. C to the result) C mounts (income earned or received as a C resident and income earned or received from C sources as a nonresident) 22 b Enter totals from Side 1, line 22a, col. through col. E...22b Educator expenses Certain business expenses of reservists, performing artists, and fee-basis government officials Health savings account deduction Moving expenses...26 D 27 Deductible part of self-employment tax Self-employed SEP, SIMPLE, and qualified plans Self-employed health insurance deduction Penalty on early withdrawal of savings alimony paid. b Enter recipient s: SSN N Last name. 31a 32 IR deduction Student loan interest deduction uition and fees Domestic production activities deduction dd line 23 through line 35 in each column, through E otal. Subtract line 36 from line 22b in each column, through E. See instructions Part III djustments to Federal Itemized Deductions 38 Federal Itemized Deductions. Enter the amount from federal Schedule (Form 1040), lines 4, 9, 15, 19, 20, 27, and 28 (or Schedule (Form 1040NR), lines 1, 5, 6, 13, and 14) Enter total of federal Schedule (Form 1040), line 5 (State Disability Insurance, and state and local income tax, or General Sales ax), and line 8 (foreign taxes only) (or Schedule (Form 1040NR), line 1). See instructions Subtract line 39 from line I ther adjustments including California lottery losses. See instructions. Specify Combine line 40 and line L Is your federal GI (Long Form 540NR, line 13) more than the amount shown below for your filing status? Single or married/rdp filing separately...$182,459 Head of household...$273,692 Married/RDP filing jointly or qualifying widow(er) $364,923 No. ransfer the amount on line 42 to line 43. Yes. Complete the Itemized Deductions Worksheet in the instructions for Schedule C (540NR), line Enter the larger of the amount on line 43 or your standard deduction. See instructions Part IV California axable Income 45 California GI. Enter your California GI from line 37, column E Enter your deductions from line Deduction Percentage. Divide line 37, column E by line 37, column D. Carry the decimal to four places. If the result is greater than 1., enter 1.. If less than zero, enter California Itemized/Standard Deductions. Multiply line 46 by the percentage on line California axable Income. Subtract line 48 from line 45. ransfer this amount to Long Form 540NR, line 35. If less than zero, enter M Side 2 Schedule C (540NR)