Form 1040-NR
2019
U.S. Nonresident Alien Income Tax Return
Department of the Treasury
Internal Revenue Service
▶
Go to www.irs.gov/Form1040NR for instructions and the latest information.
OMB No. 1545-0074
For the year January 1–December 31, 2019, or other tax year
beginning , 2019, and ending , 20
Please print
or type
Your first name and middle initial Last name Identifying number (see instructions)
Present home address (number and street or rural route). If you have a P.O. box, see instructions. Apt. no.
Check if:
Individual
Estate or Trust
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 Reserved
2 Single nonresident alien
3
Reserved
4
Reserved
5 Married nonresident alien
6
Qualifying widow(er) (see instructions)
Child’s name
▶
Dependents
If more
than four
dependents,
see instructions
and check
here.
7 Dependents: (see instructions)
(2) Dependent’s
identifying number
(3) Dependent’s
relationship to you
(4) ✔ if qualifies for (see instr.):
(1) First name Last name
Child tax credit
Credit for other dependents
Income
Effectively
Connected
With U.S.
Trade/
Business
Attach Form(s)
W-2, 1042-S,
SSA-1042S,
RRB-1042S,
and 8288-A
here. Also
attach Form(s)
1099-R if tax
was withheld.
8 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . 8
9a Taxable interest . . . . . . . . . . . . . . . . . . . . . . . . . 9a
b Tax-exempt interest. Do not include on line 9a . . . . . . . 9b
10a Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . . 10a
b Qualified dividends (see instructions) . . . . . . . . . . 10b
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 (Form 1040 or 1040-SR) . . . . . . . 13
14
Capital gain or (loss). Attach Schedule D (Form 1040 or 1040-SR) if required. If not required, check here
14
15 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . . 15
16a IRA distributions . . . . . 16a 16b
Taxable amount (see instr.)
16b
17a Pensions and annuities . . . 17a 17b
Taxable amount (see instr.)
17b
18
Rental real estate, royalties, partnerships, trusts, etc. Attach Schedule E (Form 1040 or 1040-SR)
18
19 Farm income or (loss). Attach Schedule F (Form 1040 or 1040-SR) . . . . . . . . . 19
20 Unemployment compensation . . . . . . . . . . . . . . . . . . . . 20
21 Other income. List type and amount (see instructions) 21
22
Total income exempt by a treaty from page 5, Schedule OI, item L (1(e))
22
23
Combine the amounts in the far right column for lines 8 through 21. This is your total
effectively connected income . . . . . . . . . . . . . . . . . . .
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23
Adjusted
Gross
Income
24 Educator expenses (see instructions) . . . . . . . . . . 24
25 Health savings account deduction. Attach Form 8889 . . . . . 25
26 Moving expenses for members of the Armed Forces. Attach Form
3903 . . . . . . . . . . . . . . . . . . . .
26
27 Deductible part of self-employment tax. Attach Schedule SE (Form
1040 or 1040-SR) . . . . . . . . . . . . . . . .
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 Add lines 24 through 33 . . . . . . . . . . . . . . . . . . . . . . 34
35 Adjusted Gross Income. Subtract line 34 from line 23 . . . . . . . . . . .
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35
Tax and
Credits
36 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . 36
37 Itemized deductions from page 3, Schedule A, line 8 . . . . . . . . . . . . . 37
38 Qualified business income deduction. Attach Form 8995 or Form 8995-A . . . . . . . 38
39 Exemptions for estates and trusts only (see instructions) . . . . . . . . . . . .
39
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Cat. No. 11364D
Form 1040-NR (2019)