Fillable Form 1040NR-EZ: U.S. Income Tax Return for Certain (IRS)

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Form 1040NR-EZ: U.S. Income Tax Return for Certain (IRS)

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The Form 1040NR-EZ: U.S. Income Tax Return for Certain (IRS) form is 2 pages long and contains:

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  • 26 check-boxes
  • 114 other fields

Country of origin: US
File type: PDF

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The Internal Revenue Service (IRS) is a government agency responsible for collecting taxes and administering the federal statutory tax laws of the United States. The IRS provide tax assistance to taxpayers and pursue and resolve fraudulent tax filings.

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Form 1040NR-EZ
Department of the Treasury
Internal Revenue Service
U.S. Income Tax Return for Certain
Nonresident Aliens With No Dependents
▶
Information about Form 1040NR-EZ and its instructions is at www.irs.gov/form1040nrez.
OMB No. 1545-0074
2016
Please print
or type.
See
separate
instructions.
Your first name and initial
Last name
Identifying number (see instructions)
Present home address (number, street, and apt. no., or rural route). If you have a P.O. box, see instructions.
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
Foreign country name Foreign province/state/county Foreign postal code
Filing Status
Check only one box.
1
Single nonresident alien
2
Married nonresident alien
Attach
Form(s)
W-2 or
1042-S
here.
Also
attach
Form(s)
1099-R if
tax was
withheld.
3 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . 3
4 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 4
5 Scholarship and fellowship grants. Attach Form(s) 1042-S or required statement. . 5
6
Total income exempt by a treaty from page 2, Item J(1)(e) .
6
7 Add lines 3, 4, and 5 . . . . . . . . . . . . . . . . . . . . . 7
8
Scholarship and fellowship grants excluded . . . . .
8
9 Student loan interest deduction . . . . . . . . . 9
10
Subtract the sum of line 8 and line 9 from line 7. This is your adjusted gross income .
10
11 Itemized deductions (see instructions) . . . . . . . . . . . . . . . 11
12 Subtract line 11 from line 10 . . . . . . . . . . . . . . . . . . . 12
13 Exemption (see instructions) . . . . . . . . . . . . . . . . . . . 13
14
Taxable income. Subtract line 13 from line 12. If line 13 is more than line 12, enter -0-
14
15 Tax. Find your tax in the tax table in the instructions . . . . . . . . . . . 15
16 Unreported social security and Medicare tax from Form: a 4137 b 8919 16
17 Add lines 15 and 16. This is your total tax . . . . . . . . . . . . .
▶
17
18a
Federal income tax withheld from Form(s) W-2 and 1099-R
18a
b Federal income tax withheld from Form(s) 1042-S . . . 18b
19
2016 estimated tax payments and amount applied from 2015 return
19
20 Credit for amount paid with Form 1040-C . . . . . 20
21 Add lines 18a through 20. These are your total payments . . . . . . . .
▶
21
Refund
Direct
deposit?
See
instructions.
22
If line 21 is more than line 17, subtract line 17 from line 21. This is the amount you overpaid
22
23a
Amount of line 22 you want refunded to you. If Form 8888 is attached, check here
▶
23a
b Routing number c
Type: Checking
Savings
d
Account number
e
If you want your refund check mailed to an address outside the United States not
shown above, enter that address here:
24
Amount of line 22 you want applied to your 2017 estimated tax
▶
24
Amount
You Owe
25
Amount you owe. Subtract line 21 from line 17. For details on how to pay, see instructions
▶
25
26
Estimated tax penalty (see instructions) . . . . . . .
26
Third
Party
Designee
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)
▶
Sign
Here
Keep a copy of
this return for
your records.
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
Your occupation in the United States
If the IRS sent you an Identity Protection
PIN, enter it
here (see inst.)
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer’s signature Date
Check if
self-employed
PTIN
Firm’s name
▶
Firm’s address
▶
Firm’s EIN
▶
Phone no.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.
Cat. No. 21534N
Form
1040NR-EZ (2016)
Form 1040NR-EZ (2016)
Page 2
Schedule OI—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 may 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 2016 (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
mm/dd/yy
Date departed United States
mm/dd/yy
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:
2014 , 2015
, and 2016
.
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
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).
(a) Country
(b) Tax treaty
article
(c) Number of months
claimed in prior tax years
(d) Amount of exempt
income in current tax year
(e) Total. Enter this amount on Form 1040NR-EZ, line 6. Do not enter it on line 3 or line 5 . . . . . .
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.
Form 1040NR-EZ (2016)
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Form 1040NR-EZ: U.S. Income Tax Return for Certain (IRS)

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Completed 12 April 2021

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