US Internal Revenue Service: f1040c - 2005
US Internal Revenue Service: f1040c - 2005
US Internal Revenue Service: f1040c - 2005
Form 1040-C U.S. Departing Alien Income Tax Return OMB No. 1545-0086
If a joint return, spouse’s first name and initial (see instructions) Last name Spouse’s identifying number
Print or type
U.S. address (number, street, and apt. no. or rural route) Passport or alien registration card number Original date of your entry into the U.S.
Your number Spouse’s number
City, state, and ZIP code Date of departure
Complete foreign address Date on which you last arrived in the U.S.
Of what country are you a citizen or subject? Of what country are you a resident?
A Is your employer willing to furnish a letter guaranteeing that the tax will be paid? Yes No
If “Yes,” attach the letter and leave the remainder of this form blank except for the signature area on page 2.
Caution: Form 1040-C is not a final income tax return. You must file a final return on the correct form after your tax year ends.
See Final Return Required on page 2 of the instructions.
Part I Explanation of Status—Resident or Nonresident Alien
1 Check the applicable box or boxes. Note: A nonresident alien who has income from U.S. real property may elect to treat this income
as effectively connected income. Gain or loss on the disposition of a U.S. real property interest by a nonresident alien is effectively
connected income or loss. For details, see the 2004 Form 1040NR instructions or Pub. 519, U.S. Tax Guide for Aliens.
Group I—Resident alien.
Group II—Nonresident alien with income effectively connected with a U.S. trade or business.
Group III—Nonresident alien with income not effectively connected with a U.S. trade or business.
2 Type of trade or business or occupation in the United States 䊳
3 Visa number and class under which you were last admitted to the United States 䊳
4 Do you have a permit to reenter the United States? Yes No
If “Yes,” enter the expiration date 䊳
5 Have you signed a waiver of rights, privileges, exemptions, and immunities as described under Exceptions
on page 2 of the instructions? Yes No
If “Yes,” enter the date signed 䊳
6 During your stay in the United States did you furnish either of the following forms to a withholding agent:
Form W-9, Request for Taxpayer Identification Number and Certification, or Form 1078, Certificate of Alien
Claiming Residence in the United States? Yes No
7a Have you applied for U.S. citizenship? Yes No
b Have you applied for, or taken other affirmative steps to apply for, lawful permanent resident status in the
United States, or do you have an application pending to change your status to that of a lawful permanent
resident of the United States? Yes No
8 If you filed income tax returns in the United States, give the following information for 2004:
a Type of return filed (for example, Form 1040, 1040NR, etc.) 䊳
b Your U.S. address shown on return 䊳
c Taxable income reported $ d Tax paid $ e Balance due $
9 Do you know of any current charges against you concerning your U.S. taxes for any tax period? Yes No
10 Do you plan to return to the United States? Yes No
If “Yes,” complete lines 11 through 13 below.
11 Are your spouse and any children remaining in the United States? Yes No
12 Show the approximate value and location in the United States of any property held by you:
Value Location
$
;
a Real property $ ;
b Stocks and bonds $ ;
c Cash $ ;
d Other (specify) 䊳 $ ;
13 If you will not return before (a) the due date for filing a final U.S. income tax return for the current year or (b) the due date for
filing a final U.S. income tax return for the preceding year, what arrangements have you made to file the final income tax return(s)
and pay the tax(es)? 䊳
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 7 of instructions. Cat. No. 11310F Form 1040-C (2005)
3
I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1040C, PAGE 2 of 4
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD to FOOT
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 203mm (8") 559mm (22"), FOLD TO: 203mm (8") 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Dependents on 14c
not entered above
Date , By
(Name) (Title)
Form 1040-C (2005)
3
I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1040C, PAGE 3 of 4
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD to FOOT
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 203mm (8") 559mm (22"), FOLD TO: 203mm (8") 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
2 Net gain. Combine the gains and losses entered on line 1, column (f). If the total is greater than zero,
enter this net gain amount on Schedule A, line 3, column (f) 2
2 Total itemized deductions. Add the amounts in columns (b) and (d) of line 1. Enter the total here
and on Schedule D, line 2 or line 10, whichever applies. Exception. If the amount on Form 1040-C,
line 17, is over $145,950 ($72,975 if married filing separately), see the instructions on page 6 for
the amount to enter 2
Form 1040-C (2005)
3
I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1040C, PAGE 4 of 4
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD to FOOT
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 203mm (8") 559mm (22"), FOLD TO: 203mm (8") 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Tax for Resident Alien—Group I Only (For description of groups, see line 1 on page 1.)
2 If you itemize deductions, enter amount from page 3, Schedule C, line 2 (to the extent they are
allowable on Schedule A (Form 1040)). If you do not plan to itemize deductions, enter your standard
deduction. See Standard Deduction (Group I only) on page 6 of the instructions 2
7 Alternative minimum tax (AMT). Enter the amount, if any, of AMT from Form 6251 7
8 Add lines 6 and 7. Enter the result here and on Form 1040-C, line 18 䊳 8
Tax for Nonresident Alien With Income Effectively Connected With a U.S. Trade or Business—Group II Only
10 Enter itemized deductions from page 3, Schedule C, line 2 (to the extent they are allowable on
Schedule A (Form 1040NR)) 10
14 Tax. Figure your tax on the amount on line 13 by using the 2005 Tax Rate Schedules on page 8
of the instructions. Include in the total any tax from Form 4972 and Form 8814. Enter the tax here 14
15 Alternative minimum tax (AMT). Enter the amount, if any, of AMT from Form 6251 15
16 Add lines 14 and 15. Enter the result here and on Form 1040-C, line 18 䊳 16
Form 1040-C (2005)