Form 1040 NR U.S. Nonresident Alien Income Tax Return

1040NR

Please print
or type.

OMB No. 1545-0074

U.S. Nonresident Alien Income Tax Return

Form
Department of the Treasury
beginning
Internal Revenue Service
Your first name and initial

2010

For the year January 1–December 31, 2010, or other tax year
, 2010, and ending

, 20

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.

Check if:

Individual
Estate or Trust

City, town or post office, state, and ZIP code. If you have a foreign address, see instructions.

Country ©

Filing
Status
Check only
one box.

1
2
3
If you

Single resident of Canada or Mexico or single U.S. national
Other single nonresident alien
Married resident of Canada or Mexico or married U.S. national

b

Married resident of South Korea
Other married nonresident alien
Qualifying widow(er) with dependent child (see instructions)

checked box 3 or 4 above, enter the information below.

(i) Spouse’s first name and initial

Exemptions 7a

4
5
6

(ii) Spouse’s last name

(iii) Spouse’s identifying number

Yourself. If someone can claim you as a dependent, do not check box 7a
Spouse. Check box 7b only if you checked box 3 or 4 above and your spouse did not
have any U.S. gross income

c Dependents: (see instructions)
(1) First name

Last name

(2) Dependent’s
identifying number

If more
than four
dependents,
see
instructions.

..
.
..
.
..
.
..
.

(3) Dependent’s
relationship
to you

}

(4) if qualifying
child for child tax
credit (see page 9)

No. of children on
7c who:
● lived with you

..
.
..
.
..
.
..
.

● did not live with
you due to divorce
or separation
Dependents on 7c
not entered above
Add numbers on
©
lines above

d Total number of exemptions claimed
8
9a

8 Wages, salaries, tips, etc. Attach Form(s) W-2
Income
9a
Taxable interest
Effectively
9b
b
Tax-exempt interest. Do not include on line 9a
Connected
10a Ordinary dividends
With U.S.
10b
Trade/
b Qualified dividends (see instructions)
Business
11 Taxable refunds, credits, or offsets of state and local income taxes (see instructions)
12
Attach Form(s) 13
W-2, 1042-S,
14
SSA-1042S,
15
RRB-1042S,
and 8288-A
16a
here. Also
attach Form(s) 17a
1099-R if tax
18
was withheld. 19
20
21
Enclose, but
do not attach, 22
any payment. 23

Adjusted
Gross
Income

24
25
26
27
28
29
30
31
32
33
34
35
36

10a

Scholarship and fellowship grants. Attach Form(s) 1042-S or required statement (see instructions)
Business income or (loss). Attach Schedule C or C-EZ (Form 1040)

Capital gain or (loss). Attach Schedule D (Form 1040) if required. If not required, check here
Other gains or (losses). Attach Form 4797
16a
16b Taxable amount (see instructions)
IRA distributions
17a
Pensions and annuities
17b Taxable amount (see instructions)
Rental real estate, royalties, partnerships, trusts, etc. Attach Schedule E (Form 1040)
Farm income or (loss). Attach Schedule F (Form 1040)
Unemployment compensation
Other income. List type and amount (see instructions)
22
Total income exempt by a treaty from page 5, Schedule OI, Item L (1)(e)
Combine the amounts in the far right column for lines 8 through 21. This is your total
©
effectively connected income
24
Educator expenses (see instructions)
25
Health savings account deduction. Attach Form 8889
26
Moving expenses. Attach Form 3903
27
One-half of self-employment tax. Attach Schedule SE (Form 1040)
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
Add lines 24 through 34
Subtract line 35 from line 23. This is your adjusted gross income

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.

Boxes checked
on 7a and 7b

©

Cat. No. 11364D

11
12
13
14
15
16b
17b
18
19
20
21

23

35
36
Form

1040NR

(2010)

Form 1040NR (2010)

Tax and
Credits

Other
Taxes

Payments

37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52

Amount from line 36 (adjusted gross income)
Itemized deductions from page 3, Schedule A, line 17
Subtract line 38 from line 37
Exemptions (see instructions)
Taxable income. Subtract line 40 from line 39. If line 40 is more than line 39, enter -0Tax (see instructions). Check if any tax is from: a
Form(s) 8814 b
Form 4972
Alternative minimum tax (see instructions). Attach Form 6251
©
Add lines 42 and 43
45
Foreign tax credit. Attach Form 1116 if required
46
Credit for child and dependent care expenses. Attach Form 2441
47
Retirement savings contributions credit. Attach Form 8880
48
Child tax credit (see instructions)
49
Residential energy credits. Attach Form 5695
50
Other credits from Form: a
3800 b
8801 c
Add lines 45 through 50. These are your total credits
©
Subtract line 51 from line 44. If line 51 is more than line 44, enter -0-

53

Tax on income not effectively connected with a U.S. trade or business from page 4, Schedule NEC, line 15
Self-employment tax. Attach Schedule SE (Form 1040)
Unreported social security and Medicare tax from Form: a
4137 b
8919
Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required

©

53
54
55
56
57
58
59

©

68

54
55
56
57
58
59

Transportation tax (see instructions)
a
Schedule H (Form 1040)
b
Form 5405, line 16
Add lines 52 through 58. This is your total tax

60
a
b
c
d
61
62
63
64
65
66
67
68

Refund

Page

37
38
39
40
41
42
43
44

Federal income tax withheld from:
Form(s) W-2 or 1099
Form(s) 8805
Form(s) 8288-A
Form(s) 1042-S
2010 estimated tax payments and amount applied from 2009 return
Additional child tax credit. Attach Form 8812
Amount paid with request for extension to file (see instructions)
Excess social security and tier 1 RRTA tax withheld (see instructions)
Credit for federal tax paid on fuels. Attach Form 4136

Credits from Form: a

2439 b

8839 c

8801 d

8885

Credit for amount paid with Form 1040-C
Add lines 60a through 67. These are your total payments

©

b Routing number

c Type:

51
52

60a
60b
60c
60d
61
62
63
64
65
66
67
69
70a

69 If line 68 is more than line 59, subtract line 59 from line 68. This is the amount you overpaid
©
70a Amount of line 69 you want refunded to you. If Form 8888 is attached, check here

Direct deposit?
See
instructions.

2

Checking

Savings

d Account number
e If you want your refund check mailed to an address outside the United States not shown on page 1, enter it here.

Amount
You Owe
Third Party
Designee
Sign Here
Keep a copy of
this return for
your records.

Paid
Preparer
Use Only

71
72
73

Amount of line 69 you want applied to your 2011 estimated tax ©
71
Amount you owe. Subtract line 68 from line 59. For details on how to pay, see instructions
Estimated tax penalty (see instructions)
73

Do you want to allow another person to discuss this return with the IRS (see instructions)?
Designee’s
©
name

Phone
©
no.

©

72

Yes. Complete below.

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 complete. 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

©

Print/Type preparer’s name

Firm’s name

©

Firm’s address

Preparer’s signature

Date

Check
if
self-employed
Firm’s EIN

©

PTIN

©

Phone no.
Form

1040NR

(2010)

Form 1040NR (2010)

Page

Schedule A—Itemized Deductions (See instructions.)
State and
Local
Income
Taxes

Gifts
to U.S.
Charities

Casualty and
Theft Losses

3

07

1

State income taxes

1

2

Local income taxes

2

3

Add lines 1 and 2

3

Caution: If you made a gift and received a benefit in
return, see instructions.
4

Gifts by cash or check. If you made any gift of $250 or
more, see instructions

4

5

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

5

6

Carryover from prior year

6

7

Add lines 4 through 6

7

8

Casualty or theft loss(es). Attach Form 4684. See instructions

8

9
Job
Expenses
and Certain
Miscellaneous
Deductions

Unreimbursed employee expenses—job travel, union dues,
job education, etc. You must attach Form 2106 or Form
2106-EZ if required. See instructions ©
9
10

10

Tax preparation fees

11

Other expenses. See instructions for expenses to deduct
here. List type and amount ©

11

Other
Miscellaneous
Deductions

12

Add lines 9 through 11

13

Enter the amount from Form
1040NR, line 37

14

Multiply line 13 by 2% (.02)

12

13
14

15

Subtract line 14 from line 12. If line 14 is more than line 12, enter -0-

16

Other—see instructions for expenses to deduct here. List type and amount

15
©

16

Total
Itemized
17
Deductions

Add the amounts in the far right column for lines 3 through 16. Also enter this amount
on Form 1040NR, line 38.

17
Form

1040NR

(2010)

Form 1040NR (2010)

Page

4

Schedule NEC—Tax on Income Not Effectively Connected With a U.S. Trade or Business (see instructions)
Enter amount of income under the appropriate rate of tax (see instructions)
Nature of income

(a) 10%

(b) 15%

(d) Other (specify)

(c) 30%

%
1
a
b
2
a
b
c
3
4
5
6
7
8
9
10
a
b
11
12

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
Losses
Gambling winnings —Residents of countries other than Canada.
Note. Losses not allowed
Other (specify) ©

%

1a
1b
2a
2b
2c
3
4
5
6
7
8
9

10c
11
12

13
14
15

13
Add lines 1a through 12 in columns (a) through (d)
14
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. Add columns (a) through (d) of line 14. Enter the total here and on
©
Form 1040NR, line 53

15

Capital Gains and Losses From Sales or Exchanges of Property
Enter only the capital gains and
losses from property sales or
exchanges that are from sources
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 D
(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.

16

17
18

(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.)

(d) Sales price

(e) Cost or other
basis

(g) GAIN
If (d) is more
than (e), subtract (e)
from (d)

(f) LOSS
If (e) is more
than (d), subtract (d)
from (e)

17 (
Add columns (f) and (g) of line 16
Capital gain. Combine columns (f) and (g) of line 17. Enter the net gain here and on line 9 above (if a loss, enter -0-)

)
©

18
Form

1040NR

(2010)

Form 1040NR (2010)

Page

5

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?
2. A green card holder (lawful permanent resident) of the United States?
If you answer “Yes” to 1 or 2, see Pub. 519, chapter 4, to see expatriation rules that may apply to you.

Yes
Yes

No
No

Yes

No

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?
©
If you answered “Yes,” indicate the date and nature of the change.
G List all dates you entered and left the United States during 2010 (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 Date departed United States
mm/dd/yy
mm/dd/yy

/
/
/
/

/
/
/
/

/
/
/
/

Date entered United States Date departed United States
mm/dd/yy
mm/dd/yy

/
/
/
/

/
/
/
/

/
/
/
/

/
/
/
/

/
/
/
/

H Give number of days (including vacation, nonworkdays, and partial days) you were present in the United States during:
2008
, 2009
, and 2010
.
I

Did you file a U.S. income tax return for any prior year?
If “Yes,” give the latest year and form number you filed

Yes

No

Yes

No

Yes

No

Yes
Yes

No
No

©

J Are you filing a return for a trust?
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 Did you receive total compensation of $250,000 or more during the tax year?
If “Yes,” did you use an alternative method to determine the source of this compensation?

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 and 2 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, 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?
Form

Yes

No

1040NR

(2010)