F0.1NONR

F0.1NONR Department of the Treasury Internal Revenue Service U.S. Nonresident Alien Income Tax Return Ili Go to www.irs.gov/Form1040NR for instructions and the latest information. For the year January 1-December 31. 2017. or other tax year begnning . 2017. and ending .20 OMB No. 154S-0074 0 1 7 Please print or type 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 M . box see instructions. Check it O Individual O Estate or That 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 Status Check onty one box. 1 0 Single resident of Canada or Mexico or single U.S. national 4 2 0 Other single nonresident alien 5 3 0 Married resident of Canada or Mexico or monied U.S. national 6 M Married resident of South Korea • Other married nonresident alien M Qualifying widow(er) (see instructions) If you checked box 3 or 4 above, enter the information below. Child's name O. (I) Spouse's first name and initial 00 Spouse's last name (IV) Spouse's identifying number Exemptions If more than lour dependents. see instructions 7a 0 Yourself. If someone can claim you as a dependent, do not check box 7a . . . . Boxes checked on 7a and lb b 0 Spouse. Check box 7b only if you checked box 3 or 4 above and have any U.S. gross income your spouse did not No. of children on 7c who: c Dependents: (see Instructions) (1) Frst name Last name (2) Dependent's identifying number (3) Dependent's relationship to you RV if qualifying child for child tax credit (see Instr.) . lived with you • did not live with 0 you due to divorce 0 instructions) or separation (see 0 Dependents on 7c 0 not entered above d Total number of exemptions claimed Add numbers on lines above Po Income Effectively Connected With U.S. Trade/ Business Attach Form(s) w-2, 1042-S, SSA-1042S, RRB-10425, and 8288-A here. Also attach Form(s) 1099-R if tax was withheld. 8 Wages, salaries, tips. etc. Attach Form(s) W-2 .I 8 9a Taxable interest 1 9a b Tax-exempt interest. Do not include on line 9a 19b I 10a Ordinary dividends 10a b Qualified dividends (see instructions) 110D I a 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 16a IRA distributions . . 16a 16b Taxable amount (see instructions) 16b 17a Pensions and annuities 17a 17b Taxable amount (see instructions) 17b 18 Rental real estate, royalties, partnerships, trusts, etc. Attach Schedule E Form 1040) . . 18 19 Farm income or (loss). Attach Schedule F (Form 1040) 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 01 Item L (1)(e) 122 1 23 Combine the amounts in the far right column for lines 8 through 21. effectively connected income This is your total Il. 23 Adjusted Gross Income 24 Educator expenses (see instructions) 24 25 Health savings account deduction. Attach Form 8889 . . . 25 I 26 Moving expenses. Attach Form 3903 26 27 Deductible part of self-employment tax. Attach Schedule SE (Form 1040) 27 28 Self-employed SEP, SIMPLE, and qualified plans . . . . 29 Self-employed health insurance deduction (see instructions) 30 Penalty on early withdrawal of savings 31 Scholarship and fellowship grants excluded 32 IRA deduction (see instructions) 33 Student loan interest deduction (see instructions) . . . 34 Domestic production activities deduction. Attach Form 8903 28 29 30 31 32 _33 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 Tax and Credits 37 Amount from line 36 (adjusted gross income) 38 Itemized deductions from page 3, Schedule A, line 15 39 Subtract line 38 from line 37 40 Exemptions (see instructions) 41 Taxable income. Subtract line 40 from line 39. If line 40 is more 42 Tax (see inst.). Check if any is from Form(s): a O8814 bO 4972 43 Alternative minimum tax (see instructions). Attach Form 6251 44 Excess advance premium tax credit repayment. Attach Form 8962 45 Add lines 42, 43. and 44 46 Foreign tax credit. Attach Font, 1116 if required than line 46 39, enter -0- . lir. 37 38 39 40 41 42 43 44 45 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 53 Subtract line 52 from line 45. If line 52 is more than line 45. enter -0- P. 52 53 Other Taxes 54 Tax on income not effectively connected with a U.S. trade or business from page 4. Schedule 55 Self-employment tax. Attach Schedule SE (Form 1040) 56 Unreported social security and Medicare tax from Form: a O 4137 b 57 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 58 Transportation tax (see instructions) 59a Household employment taxes from Schedule II (Form 1040) b First-time homebuyer credit repayment. Attach Form 5405 if required 60 Taxes from: a O Form 8959 b O Instructions; enter code(s) 61 Add lines 53 through 60. This is your total tax NEC, line 15 • 8919 if required e. 54 55 56 57 58 59a 59b 60 61 Payments 62 Federal income tax withheld from: 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 Refund Direct deposit? See instructions. 72 If line 71 is more than line 61, subtract line 61 from line 71. This is the amount you overpaid 73a Amount of line 72 'you want refunded to ou. If Form 8888 is attached, check here . a. O 72 73a b Routing number I 1 PP c Type: O Checkir O Savings 75 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 You Owe 75 Amount you owe. Subtract line 71 from line 61. For details on how to pay, see instructions IP 76 Estimated tax penalty (see instructions) I 76 I Third Party Designee Do you want to allow another person to discuss this return with the IRS? See instructions O Yes. Complete below. Phone Personal identification • No Designee's name s. no. 0. number (PIN) pi I I I I I Sign Here Keep a copy of this return for your records. Unde beeer. pena they altireesvofnet.321y. I.dnencellanre thltelIehaye Dec at examined Onn)this Your signature return preparer and Date accom n panying)T.:hedu baseldensnanacj isntiiinttemenls.nr: ilttnodihe Vow occupation ri the United States best nre orfnmaz knowled any ge andn If the IRS sent you an Identity Protection PIN. enter it here (see instr.) 1 1 1 1 1 1 1 Paid Preparer u se o n ly Printaype preparets name Preparers signature Date Check O If self-employed PTIN 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 Gifts Caution: If you made a gift and received a benefit in return, see instructions. to U.S. Charities 2 Gifts by cash or check. If you made any gift of $250 or more. 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 Expenses and Certain 7 Unreimbursed employee expenses—job travel. union dues. job education. etc. You must attach Form 2106 or Form 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 Other 14 Other —see instructions for expenses to deduct here. List type and amount DP Miscellaneous Deductions 14 Total Itemized 15 Is Form 1040NR. line 37, over the amount shown below for the filing status box you checked on page 1 of Form 1040NR: 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 Nature of Income Enter amount of income under the appropriate rate of tax see Instructions) (a) 10% (W15% (c) 30% (d) Other (specify) 1 a b 2 a b c 3 4 5 6 7 8 9 10 a b 11 12 13 14 15 Dividends paid by: U.S. corporations Foreign corporations Interest: Mortgage Paid by foreign corporations Other Industrial royalties (patents, trademarks, etc.) Motion picture or T.V. copyright royalties Other royalties (copyrights, recording. publishing, etc .) Real property income and natural resources royalties Pensions and annuities Social security benefits Capital gain from line 18 below Gambling—Residents of Canada only. Enter net income in column (c). If zero or less, enter -0-. Winnings 1a lb 2a 2b 2c 3 4 5 6 7 8 9 10c 11 ___ _ Losses Gambling winnings—Residents of countries other than Canada. Note: Losses not allowed Other (specify) ► Add lines 1a through 12 in columns (a) through (d) Multiply line 13 by rate of tax at top of each column Tax on income not effectively connected with a U.S. trade or business. Form 1040NR, line 54 12 13 14 Add columns (a) through (d) of line 14. Enter the total here and on ► 15 Enter only the capital gains and losses front property sales at exchanges that are from gamete within the United States and not effectively 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), Form 4797. or both. Capital Gains and Losses From Sales or Exchanges of Property 16 (a) Kind of property and description (if necessary. attach statement of descriptive details not shown below) (b) Date acquired (mo.. day. yr.) (c) Date sold (mo.. day, yr.) (4 Sales price (e) Cost or other basis (0 LOSS If (e) is more than (d). subtract (d) from (a) (g) (MIN If (d) is more than (e). subtract (e) from (d) 17 Add columns (f) and (g) of line 16 117 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? K Yes K No D Were you ever: 1. A U.S. citizen? K Yes K No 2. A green card holder (lawful permanent resident) of the United States? K Yes K 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? K Yes K 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 K Canada K Mexico Date entered United States mmicid/yy Date departed United States mmicid/yy Date entered United States mmiddiyy Date departed United States 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? K Yes K No If "Yes." give the latest year and form number you filed . . . ► J Are you filing a return for a trust? K Yes K 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/ K Yes K No K Did you receive total compensation of 6250,000 or more during the tax year? K Yes K No If "Yes," did you use an alternative method to determine the source of this compensation/ K Yes K 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. (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, 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/ K Yes K No 3. Are you claiming treaty benefits pursuant to a Competent Authority determination? K Yes K No If "Yes." attach a copy of the Competent Authority determination letter to your return. Forrri1040NR (2017) EFTA01222565