U.S. Individual Income Tax Return

2012

Department of the Treasury
Internal Revenue Service

Instructions for Form 8854
Initial and Annual Expatriation Statement
Section references are to the Internal Revenue
Code unless otherwise noted.

Future Developments

For the latest information about
developments related to Form 8854 and
its instructions, such as legislation
enacted after they were published, go to
www.irs.gov/form8854.

General Instructions
Purpose of Form

Expatriation tax provisions apply to U.S.
citizens who have relinquished their
citizenship and long-term residents who
have ended their residency
(expatriated). Form 8854 is used by
individuals who have expatriated on or
after June 4, 2004.
The date on which you are
considered to have expatriated
determines which Parts of the form you
must complete. You are considered to
have expatriated on the date you
relinquished your citizenship (in the
case of a former citizen) or terminated
your long-term residency status (in the
case of a former U.S. resident). If you
expatriated after June 3, 2004, and
before June 17, 2008, see the relevant
section under General Instructions and
complete Parts I, II, and V. If you
expatriated after June 16, 2008, and
before January 1, 2012, see the
relevant section under General
Instructions and complete Parts I and III.
If you expatriated in 2012, complete
Parts I, IV, and V.

Expatriation. Expatriation includes the
acts of relinquishing U.S. citizenship
and terminating long-term residency.
Date of relinquishment of U.S.
citizenship. You are considered to
have relinquished your U.S. citizenship
on the earliest of the following dates.
1. The date you renounced your
U.S. citizenship before a diplomatic or
consular officer of the United States
(provided that the voluntary
renouncement was later confirmed by
the issuance of a certificate of loss of
nationality).
2. The date you furnished to the
State Department a signed statement of
your voluntary relinquishment of U.S.
Oct 05, 2012

nationality confirming the performance
of an expatriating act (provided that the
voluntary relinquishment was later
confirmed by the issuance of a
certificate of loss of nationality).
3. The date the State Department
issued a certificate of loss of nationality.
4. The date a U.S. court canceled
your certificate of naturalization.
Date of termination of long-term
residency. If you were a U.S.
long-term resident (LTR), you
terminated your lawful permanent
residency on the earliest of the following
dates.
1. The date you voluntarily
abandoned your lawful permanent
resident status by filing Department of
Homeland Security Form I-407 with a
U.S. consular or immigration officer, and
the Department of Homeland Security
determined that you had, in fact,
abandoned your lawful permanent
resident status.
2. The date you became subject to
a final administrative order for your
removal from the United States under
the Immigration and Nationality Act and
you actually left the United States as a
result of that order.
3. If you were a dual resident of the
United States and a country with which
the United States has an income tax
treaty, the date you commenced to be
treated as a resident of that country and
you determined that, for purposes of the
treaty, you are a resident of the treaty
country and gave notice to the
Secretary of such treatment. See
Regulations section 301.7701(b)-7 for
information on other filing requirements
if you are such an individual.
Long-term resident (LTR) defined.
You are an LTR if you were a lawful
permanent resident of the United States
in at least 8 of the last 15 tax years
ending with the year your status as an
LTR ends. In determining if you meet
the 8-year requirement, do not count
any year that you were treated as a
resident of a foreign country under a tax
treaty and did not waive treaty benefits
applicable to residents of the country.
Lawful permanent resident. You
are a lawful permanent resident of the
Cat. No. 24874E

United States if you have been given the
privilege, according to U.S. immigration
laws, of residing permanently in the
United States as an immigrant. You
generally have this status if you have
been issued an alien registration card,
also known as a “green card,” and your
green card has not been revoked or
judicially or administratively determined
to have been abandoned, and you have
not elected to be treated as a resident of
a foreign country under a tax treaty
between the United States and such
foreign country. If you elected to be
treated as a resident of a foreign country
under a tax treaty, have not waived the
benefits of such treaty applicable to
foreign residents, and have notified the
IRS of such a position on a Form 8833,
you are not treated as a lawful
permanent resident and you will be
treated as having expatriated if you
were a LTR at the time you elected to be
treated as a resident of such foreign
treaty country.

Expatriation After
June 3, 2004, and
Before June 17, 2008

The rules in this section apply to
persons who are considered to have
expatriated after June 3, 2004, and
before June 17, 2008.

Date of Tax Expatriation
For purposes of filling out Part I, the
date of your expatriation is the later of
the date you notified the relevant
agency of your expatriating act or the
date Form 8854 was first filed in
accordance with these instructions.
Apply the rules of section 7502 to
determine the date on which this form is
filed. Generally, the postmark date is the
filing date.
Until you file Form 8854 and
notify the Department of State
CAUTION
or the Department of Homeland
Security of your expatriating act, your
expatriation for immigration purposes
does not relieve you of your obligation to
file U.S. tax returns and report your
worldwide income as a citizen or
resident of the United States.

!

Who Must File
You must file Form 8854 to:
Establish that you have expatriated
for tax purposes; or
Comply with the annual information
reporting requirements of section
6039G, if you are subject to tax under
section 877.
Note. If you were a naturalized citizen,
but lost your citizenship because a
federal court revoked your naturalization
under section 340 of the Immigration
and Nationality Act, you do not need to
complete this form if, after the
revocation, you hold the status under
the Immigration and Nationality Act of
an alien lawfully admitted for permanent
residence. You must complete this form,
however, if you were a naturalized
citizen and you gave up your citizenship
by expatriation under section 349 of the
Immigration and Nationality Act.

Taxation Under Section 877
You are subject to taxation under
section 877 if you are a former U.S.
citizen or former LTR and any one of the
following applies to you.
1. Your average annual net income
tax liability for the 5 tax years ending
before the date of your expatriation is
more than the amount listed next.
a. $124,000 if you expatriated in
2004.
b. $127,000 if you expatriated in
2005.
c. $131,000 if you expatriated in
2006.
d. $136,000 if you expatriated in
2007.
e. $139,000 if you expatriated in
2008.
2. Your net worth is $2 million or
more on the date of your expatriation.
3. You fail to certify on Form 8854
that you have complied with all of your
federal tax obligations for the 5 tax
years preceding the date of your
expatriation.
If you are subject to tax under section
877, you are no longer taxed as a
citizen or resident on your worldwide
income. However, you must compute
your tax as a nonresident according to
the special rules of section 877. These
rules expand the categories of income
and gain on which you owe tax. You are
also subject to special rules for gift and
estate tax purposes that differ from
those applicable to other nonresident
aliens.

Tax consequences of presence in
the United States after expatriation.
If, for any tax year during the 10-year
period in which you are otherwise
subject to section 877, you are present
in the United States for more than 30
days in a calendar year ending in such
tax year, you will be treated as a U.S.
citizen or resident for that tax year. You
will be subject to U.S. tax on your
worldwide income unless the following
exception applies.
Exception. You can be present in
the United States for up to 60 days
without being treated as a U.S. citizen or
resident if you are performing personal
services in the United States for an
employer who is not related (within the
meaning of sections 267 and 707) to
you and you meet either of the following
requirements.
You were a U.S. citizen and, within a
reasonable period following your
expatriation, you became a citizen or
resident fully liable to tax in the country
in which you, your spouse, or either of
your parents was born; or
For each year in the 10-year period
ending on the date of expatriation, you
were physically present in the United
States for 30 days or less.
See Pub. 519, U.S. Tax Guide for
Aliens, for details about what constitutes
a day of presence in the United States.

When To File
File your initial Form 8854 as soon as
possible after the date you relinquish
U.S. citizenship or terminate your
long-term residence. You remain
subject to tax as a U.S. citizen or
resident until you both file your initial
Form 8854 and notify the appropriate
authorities of your expatriating act. See
the Caution in Date of Tax Expatriation,
earlier.
In most cases, you must file your
annual Form 8854 by the due date for
filing Form 1040NR, U.S. Nonresident
Alien Income Tax Return, regardless of
whether you are required to file Form
1040NR. If you are required to file Form
1040NR, attach Form 8854 to your
Form 1040NR and file your Form
1040NR at the address in the
Instructions for Form 1040NR. Also
send a copy of Form 8854 to the
address under Where To File below. If
you are not required to file Form
1040NR, send your Form 8854 to the
address under Where To File below.
If you are present in the United
States following your expatriation and
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are subject to tax as a U.S. citizen or
resident under the rules described in
Exception, earlier, file Form 8854 with
your Form 1040 by the due date for
filing Form 1040. Also send a copy of
Form 8854 to the address under Where
To File below by the due date for filing
Form 1040.

Where To File
Send your Form 8854 (or a copy of your
Form 8854 if you are required to attach
the original to a Form 1040NR or a Form
1040) to this address.
Department of the Treasury
Internal Revenue Service
Philadelphia, PA 19255-0549

Expatriation After
June 16, 2008

The rules in this section apply to
persons who are considered to have
expatriated after June 16, 2008.

Who Must File
If you expatriated after June 16, 2008,
the expatriation rules apply to you if any
of the following statements apply.
1. Your average annual net income
tax liability for the 5 tax years ending
before the date of expatriation is more
than the amount listed next.
a. $139,000 for 2008.
b. $145,000 for 2009.
c. $145,000 for 2010.
d. $147,000 for 2011.
e. $151,000 for 2012.
2. Your net worth was $2 million or
more on the date of your expatriation.
3. You fail to certify on Form 8854
that you have complied with all federal
tax obligations for the 5 tax years
preceding the date of your expatriation.
4. You expatriated before 2012 and
you:
a. Deferred the payment of tax,
b. Have an item of eligible deferred
compensation, or
c. Have an interest in a nongrantor
trust.
Covered expatriate. You are a
covered expatriate if at least one of the
statements in paragraphs (1), (2), or (3),
set out above (under Who Must File)
applies.
Exception for dual-citizens and
certain minors. Dual-citizens and
certain minors (defined next) will not be
treated as covered expatriates (and

therefore will not be subject to the
expatriation tax) solely because one or
both of the statements in paragraph (1)
or (2) above (under Who Must File)
applies. However, these individuals will
still be treated as covered expatriates
unless they file Form 8854 and certify
that they have complied with all federal
tax obligations for the 5 tax years
preceding the date of expatriation as
required in paragraph (3) above (under
Who Must File).
Certain dual-citizens. You may
qualify for the exception described
above if you meet both of the following
requirements.
You became at birth a U.S. citizen
and a citizen of another country and you
continue to be a citizen of, and are
taxed as a resident of, that other
country.
You were a resident of the United
States for not more than 10 years during
the 15-tax-year period ending with the
tax year during which the expatriation
occurred. For the purpose of
determining U.S. residency, use the
substantial presence test described in
chapter 1 of Pub. 519.
Certain minors. You may qualify for
the exception described above if you
meet both of the following requirements.
You expatriated before you were
181 2.
You were a resident of the United
States for not more than 10 tax years
before the expatriation occurs. For the
purpose of determining U.S. residency,
use the substantial presence test
described in chapter 1 of Pub. 519.

Taxation Under Section 877A
If you are a covered expatriate in the
year you expatriate, you are subject to
income tax on the net unrealized gain in
your property as if the property had
been sold for its fair market value on the
day before your expatriation date
(“mark-to-market tax”). This applies to
most types of property interests you
held on the date of your expatriation.
But see Exceptions below.
Gains from deemed sales are taken
into account without regard to other U.S.
internal revenue laws. Losses from
deemed sales are taken into account to
the extent otherwise allowed under U.S.
internal revenue laws. However, section
1091 (relating to the disallowance of
losses on wash sales of stock and
securities) does not apply. The net gain
that you otherwise must include in your
income is reduced (but not below zero)
by $651,000.

Exceptions. The mark-to-market tax
does not apply to the following.
1. Eligible deferred compensation
items.
2. Ineligible deferred compensation
items.
3. Specified tax deferred accounts.
4. Interests in nongrantor trusts.
Instead, items (1) and (4) are subject to
withholding at source. In the case of
item (2), you are treated as receiving the
present value of your accrued benefit as
of the day before the expatriation date.
In the case of item (3), you are treated
as receiving a distribution of your entire
interest in the account on the day before
your expatriation date. See paragraphs
(d), (e), and (f) of section 877A for more
information.
Deferral of the payment of
mark-to-market tax. You can make an
irrevocable election to defer the
payment of the mark-to-market tax
imposed on the deemed sale of
property. If you make this election, the
following rules apply.
1. You make the election on a
property-by-property basis.
2. The deferred tax on a particular
property is due on the return for the tax
year in which you dispose of the
property.
3. Interest is charged for the period
the tax is deferred.
4. The due date for the payment of
the deferred tax cannot be extended
beyond the earlier of the following
dates.
a. The due date of the return
required for the year of death.
b. The time that the security
provided for the property fails to be
adequate. See item (6) below.
5. You make the election in Part IV,
Section C.
6. You must provide adequate
security (such as a bond).
7. You must make an irrevocable
waiver of any right under any treaty of
the United States that would preclude
assessment or collection of any tax
imposed by section 877A.

When To File
If you expatriated after June 16, 2008,
attach Form 8854 to your income tax
return (Form 1040 or Form 1040NR) for
the year that includes your expatriation
date, and file your return by the due
date of your tax return (including
extensions). Also send a copy of your
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Form 8854 to the address in Where To
File, later. If you are not required to file
Form 1040NR or Form 1040, send your
Form 8854 to the address in Where To
File, later, by the date your Form
1040NR (or Form 1040) would have
been due (including extensions) if you
had been required to file. (See Resident
Alien or Nonresident Alien in the
Instructions for Form 1040NR.)
Note. If you elected to defer the
payment of any tax due (see Section
C—Deferral of Tax, later), you must file
Form 8854 annually for each year up to
and including the year in which the full
amount of deferred tax and interest is
paid. For each year that you are
required to file a Form 1040NR (or Form
1040), attach your annual Form 8854 to
your Form 1040NR (or Form 1040) and
send a copy to the address under
Where To File, later. For each year that
you are not required to file Form
1040NR (or Form 1040), send your
Form 8854 to the address in Where To
File, later, by the date your Form
1040NR (or Form 1040) would have
been due (including extensions) if you
had been required to file a Form
1040NR (or Form 1040).

Where To File
Send your Form 8854 (or a copy of your
Form 8854 if you are required to attach
the original to a Form 1040NR or a Form
1040) to this address.
Department of the Treasury
Internal Revenue Service
Philadelphia, PA 19255-0549
.

Specific Instructions

See Chart A to determine which Parts of
Form 8854 you must complete.

Chart A. Which Parts To Complete
IF your expatriation
date is:

THEN you must
complete the following
Parts.
I

II

III

IV

V

After June 3, 2004,
and before June 17,
2008
After June 16,
2008, and before
January 1, 2012 *
During 2012
* Only if you deferred the payment of tax OR have an
item of eligible deferred compensation OR have an
interest in a nongrantor trust.

Identifying number. Generally, this
number is your U.S. social security
number. An incorrect or missing
identifying number may result in a
continued obligation to file U.S. tax
returns as a citizen or resident of the
United States for persons expatriating
after June 3, 2004, and before June 17,
2008, and/or a penalty of $10,000. If you
were never issued a social security
number, please attach a statement
explaining the reason.

Part I — General
Information

This section is to be completed by all
filers.

Line 1
If you have a P.O. box, enter your box
number instead of your street address
only if your post office does not deliver
mail to the street address.

Line 2
Enter the information in the following
order: street address, city, province or
state, and country. Follow the country's
practice for entering the postal code. Do
not abbreviate the country name.

Line 3
Enter the country of which you are
considered a resident for tax purposes if
it is different from the country in which
your principal foreign residence is
located.

Line 4
Your expatriation date is the date you
relinquish citizenship (in the case of a
former citizen) or terminate your
long-term residency (in the case of a
former U.S. resident). See Date of
relinquishment of U.S. citizenship or
Date of termination of long-term
residency, earlier.

Line 5

Long-term resident. Check this box if
you are a former LTR, and enter the
date on which you gave notice of
termination of your lawful permanent
resident status to the Department of
Homeland Security.
Long-term resident with dual residency. Check this box if you are an
LTR with dual residency in a treaty
country, and enter the date you
commenced to be treated for tax
purposes as a resident of the treaty
country (see Date of termination of
long-term residency, earlier).
If you are a person who expatriated
after June 16, 2008, you expatriated as
of the date that you commence to be
treated for tax purposes as a resident of
the treaty country. But you must notify
the IRS by filing a Form 8833,
Treaty-Based Return Position
Disclosure Under Section 6114 or
7701(b), and a Form 8854 to avoid
penalties.

Line 6
Enter the number of days or parts of
days you were physically present in the
United States during the year.
If you expatriated after June 3,
2004, and before June 17,
CAUTION
2008, and were physically
present in the United States for more
than 60 days during the tax year, you
will be taxed as a U.S. citizen or
resident for that tax year. For more
information, see Tax consequences of
presence in the United States after
expatriation, earlier.

!

Line 7
List all countries (other than the United
States) of which you are a citizen and
the date on which you became a citizen.

Line 8
If you are a former U.S. citizen, indicate
how you became a U.S. citizen.

If you are a person who expatriated after
June 3, 2004, and before June 17,
2008, and you have not yet notified the
Secretary of State or Secretary of
Homeland Security in connection with
your expatriating act, you must file an
amended Form 8854 stating the date on
which such notification occurs.

Part II—For Persons
Who Expatriated
After June 3, 2004, and
Before June 17, 2008

Citizen. Check this box if you are a
former U.S. citizen, and enter the date
on which you gave notice of your
expatriation to the Department of State.

Check the “No” box if you expatriated
after June 3, 2004, and before June 17,
2008, and have not previously filed
Form 8854. You must complete Form
8854 for the year in which you

Line 1

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expatriated for immigration purposes
before you can file Form 8854 for the
current year. You can download Form
8854 for any year at www.irs.gov/
form 8854.
Check the “Yes” box if you
completed Form 8854 for any period
after June 3, 2004, and before June 17,
2008. Enter the tax year for which you
first filed Form 8854 and go to line 2.

Line 2
If you were physically present in the
United States more than 30 days but not
more than 60 days during the tax year,
complete lines 2a and 2b. If you answer
“No” to either question, you will be taxed
as a U.S. citizen or resident and must
file Form 1040 for the current tax year. If
you answer “Yes” to both questions, you
remain subject to section 877 for the tax
year.

Part III—For Persons
Who Expatriated
After June 16, 2008, and
Before January 1, 2012

You must file Part III if you:
1. Deferred the payment of tax on
any property on a Form 8854 filed in a
previous year;
2. Reported an eligible deferred
compensation item on a Form 8854 filed
in a previous year; or
3. Reported an interest in a
nongrantor trust on a Form 8854 filed in
a previous year.

Line 1
If you deferred the payment of tax in an
earlier year, refer to the Form 8854 you
filed for that earlier year to complete
columns (a), (b), and (c). For 2008, use
the information from Part B, line 8; for
2009, use the information from Part IV,
line 9; for 2010 and 2011, use the
information from Part IV, line 8.
If you disposed of any property in
2012 on which you deferred the
payment of tax on a previous return,
also complete column (d). You must
report the gain or loss from the property
disposed of on the appropriate line (or
schedule) of Form 1040NR.

You must pay the deferred tax,
plus interest, on any property
CAUTION
you disposed of, no later than
the due date (without extensions) of
your 2012 Form 1040NR. See
Satisfying your deferred tax liability,
later, for information on arranging
payment.

!

Line 2
Check the “Yes” box if you received any
distributions of eligible deferred
compensation items in 2012. Enter the
part of the distribution that you would
include in gross income if you continued
to be subject to tax as a U.S. citizen or
resident. Also enter the total amount of
tax withheld by the payer(s) of any
eligible deferred compensation items.
Do not enter the part of any
payment that is attributable to
CAUTION
services performed outside the
United States before or after the
expatriation date while you were not a
citizen or resident of the United States.

!

Line 3
Unless the exception at the end of this
section applies, check the “Yes” box if
you received any direct or indirect
distributions of property (including
money) from a nongrantor trust in 2012.
Enter the part of the distribution that you
would include in gross income if you
continued to be subject to tax as a U.S.
citizen or resident. Also enter the total
amount of tax withheld by the payer(s)
of any distribution.
Do not include any distribution
from a trust if your interest in
CAUTION
the trust was treated in an
earlier year as a deferred compensation
item or part of a specified tax deferred
account.

!

Exception. Do not check the “Yes” box
if you elected on a previously filed Form
8854 to be treated as having received
the value of your entire interest in the
trust as of the day before your
expatriation date.

Part IV—For Persons
Who Expatriated
During 2012
Section A—Expatriation
Information

This section must be completed by all
individuals who expatriated in 2012.

Line 2
You can use the balance sheet in Part V
(Schedule A) to arrive at your net worth.

Line 5
Check the “Yes” box if:
You expatriated before you were
181 2, and
You have been a resident of the
United States for not more than 10 tax
years before you expatriated. For the
purpose of determining U.S. residency,
use the substantial presence test
described in chapter 1 of Pub. 519.

Line 6
Check the “Yes” box if you have
complied with your tax obligations for
the 5 tax years ending before the date
on which you expatriated, including but
not limited to, your obligations to file
income tax, employment tax, gift tax,
and information returns, if applicable,
and your obligation to pay all relevant
tax liabilities, interest, and penalties.
You will be subject to tax under section
877A if you have not complied with
these obligations, regardless of whether
your average annual income tax liability
or net worth exceeds the applicable
threshold amounts.

Section B—Property Owned
on Date of Expatriation

Complete Section B only if you are a
covered expatriate (see Covered
expatriate, earlier). If you need
additional space for the description of
property, or if you need additional entry
lines, attach a continuation statement.

Line 7
None of the amounts checked on line 7
are subject to the mark-to-market tax.
Do not include them on line 8.
Some of these amounts may
be otherwise taxable or subject
to income tax withholding at
source. You must provide Form W-8CE
to the payer of the relevant items. See
paragraphs (d), (e), and (f) of section
877A for more information.

TIP

Line 7a. Generally, a deferred
compensation item is one of the
following.
1. Any interest in a plan or
arrangement described in section
219(g)(5). This includes a qualified
pension, profit-sharing (including
401(k)), annuity, SEP, and SIMPLE
plan.

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2. Any interest in a foreign pension
plan or similar retirement arrangement
or program.
3. Any item of deferred
compensation. This is any amount of
compensation if, under the terms of the
plan, contract, or other arrangement
providing for such compensation, the
following conditions were met.
a. You had a legally binding right on
your expatriation date to such
compensation,
b. The compensation has not been
actually or constructively received on or
before the expatriation date, and
c. The compensation is payable on
or after the expatriation date.
Examples of items of deferred
compensation include: a cash-settled
stock appreciation right, a phantom
stock arrangement, a cash-settled
restricted stock unit, an unfunded and
unsecured promise to pay money or
other compensation in the future (other
than such a promise to transfer property
in the future), and an interest in a trust
described in section 402(b)(1) or (4)
(commonly referred to as a secular
trust).
4. Any property, or right to property,
that you are entitled to receive in
connection with the performance of
services to the extent not previously
taken into account under section 83 or
in accordance with section 83.
Examples of these items include, but
are not limited to, restricted stock,
stock-settled stock appreciation rights,
and stock-settled restricted stock units.
For more information, see section 5B of
Notice 2009-85, 2009-45 I.R.B. 598,
available at www.irs.gov/irb/
2009-45_IRB/ar10.html.
Eligible deferred compensation item
means any deferred compensation item
with respect to which: (i) the payer is
either a U.S. person or a non-U.S.
person who elects to be treated as a
U.S. person for purposes of section
877A(d)(1) and (ii) the covered
expatriate notifies the payer of his or her
status as a covered expatriate and
irrevocably waives any right to claim any
withholding reduction on such item
under any treaty with the United States.
Special guidance will be issued
providing a procedure for a payer who is
a non-U.S. person and wishes to be
treated as a U.S. person for purposes of
section 877A(d)(1).
Note. If you have more than one
eligible deferred compensation item,
you must attach a statement to the form
that separately identifies each eligible

deferred compensation item and
includes the following language for each
item. “I irrevocably waive any right to
claim any reduction in withholding for
this eligible deferred compensation item
under any treaty with the United States.”
Line 7b. Ineligible deferred
compensation item means any deferred
compensation item that is not an eligible
deferred compensation item.
Note. If you have more than one
ineligible deferred compensation item,
you must attach a statement to the form
that separately identifies each ineligible
deferred compensation item and
provides the present value of such
ineligible deferred compensation item
as of the day before your expatriation
date.
Line 7c. A specified tax deferred
account includes:
1. An individual retirement plan
(except those described in section
408(k) or 408(p)),
2. A Coverdell education savings
account, or
3. A health savings account or an
Archer medical savings account.
Note. If you have more than one
specified tax deferred account, you
must attach a statement to the form that
separately identifies each specified tax
deferred account and provides the
entire account balance of each
specified tax deferred account on the
day before your expatriation date.
Line 7d. A nongrantor trust is the part
of any trust, whether domestic or
foreign, of which you were not
considered the owner on the day before
your expatriation date. You are
considered a beneficiary of such trust if:
1. You are entitled or permitted,
under the terms of the trust instrument
or applicable local law, to receive a
direct or indirect distribution of trust
income or corpus (including, for
example, a distribution in discharge of
an obligation);
2. You have the power to apply trust
income or corpus for your own benefit;
or
3. You could be paid from the trust
income or corpus if the trust or the
current interests in the trust were
terminated.
Unless you elect to be treated as
having received the value of your
interest in the trust, as determined for
purposes of section 877A, as of the day
before your expatriation date, you may
not claim a reduction in withholding on

any distribution from the trust under any
treaty with the United States. Before you
can make the election, you must get a
letter ruling from the IRS as to the value,
if ascertainable, of your interest in the
trust as of the day before the
expatriation date by following the
procedures set forth in Rev. Proc.
2012-1, 2012-1 I.R.B. 1, available at
www.irs.gov/irb/2012-01_IRB/ar06.html.
You must make this election by
checking the box under line 7d of this
form and attaching a copy of the letter
ruling both to this form and to your
timely filed tax return (including
extensions) for the 2012 tax year. Until
you obtain the valuation letter ruling and
provide a copy of such letter ruling to
the trustee of the nongrantor trust
together with certification, under
penalties of perjury, that you have paid
all tax due as a result of your election,
any taxable distributions that you
receive from the trust will be subject to
30% withholding.
Note. If you have an interest in more
than one nongrantor trust, you must
attach a statement to the form that
separately identifies each nongrantor
trust and includes one of the following
statements for each interest.
1. “I waive any right to claim any
reduction in withholding on any
distribution from such trust under any
treaty with the United States.”, or
2. “I elect under section 877A(f)(4)
(B) to be treated as having received the
value of my entire interest in the trust
(as determined for purposes of section
877A) as of the day before my
expatriation date. I attach a copy of my
valuation letter ruling issued by the
IRS. ”

Line 8
Column (a). An interest in property
includes money or other property,
regardless of whether it produces any
income or gain. In addition, an interest
in the right to use property will be
treated as an interest in such property.
However, do not list the following.
1. Deferred compensation items.
2. Specified tax deferred accounts.
3. Interests in nongrantor trusts.
You are considered to own any
interest in property that would be
included in your gross estate for federal
estate tax purposes under Chapter 11 of
Subtitle B of the Code if you died on the
day before the expatriation date as a
citizen or resident of the United States.
Whether property would be included in
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your gross estate will be determined
without regard to sections 2010 through
2016. For this purpose, you are
considered to own your beneficial
interest(s) in each trust (or part of a
trust), other than a nongrantor trust
subject to section 877A(f), that would
not be included in your gross estate as
described in the preceding sentences.
Your beneficial interest(s) in such a trust
shall be determined under the special
rules set forth in section III of Notice
97-19, which is on page 40 of Internal
Revenue Bulletin 1997-10 at
www.irs.gov/pub/irs-irbs/irb97-10.pdf.
Column (b). Use the fair market value
(FMV) on the day before your
expatriation date. FMV is the price at
which the property would change hands
between a buyer and a seller when both
have reasonable knowledge of all the
necessary facts and neither has to buy
or sell. If parties with adverse interests
place a value on property in an
arm's-length transaction, that is strong
evidence of FMV.
Column (c). Generally, the cost or
other basis in this column cannot be
less than the fair market value of the
property on the date you first became a
U.S. resident. However, you can make
an irrevocable election to determine
basis without regard to this restriction.
Print “(h)(2)” after any entry for which
you make this election.
Column (e). Before you complete
column (e), you must allocate the
exclusion amount to the gain properties
on a separate schedule. Attach a copy
of the separate schedule to this form. To
allocate the exclusion amount,
determine the gain of each gain
property listed in column (a) and enter
that gain in column (d). If the total gain
of all the gain properties exceeds the
exclusion amount ($651,000), then
allocate the entire exclusion amount to
the gain properties by multiplying the
exclusion amount by the ratio of the gain
determined for each gain property in
column (d) over the total gain of all gain
properties listed in column (d). After you
have allocated the exclusion amount to
the gain properties, subtract the
exclusion amount allocated to each gain
property from the gain reported for that
property in column (d), and enter the
resulting amount of gain in column (e). If
the total gain of the gain properties in
column (d) is less than the exclusion
amount (but greater than -0-), then you
must use the total gain amount as the
exclusion amount, and you must
allocate the exclusion amount, as
adjusted, to the gain properties under

the method described above. The
exclusion amount allocated to each gain
property may not exceed the amount of
that gain property's built-in gain.
See Notice 2009-85, section 3B, for
more information.
Example. X, a covered expatriate,
renounced his citizenship on Date 2. On
Date 1, the day before X's renunciation
of his citizenship, X owned three assets,
which he had owned for more than one
year. Asset A is business property and
assets B and C are personal property.
As of Date 1, Asset A had a fair market
value of $2,000,000 and a basis of
$200,000; Asset B had a fair market
value of $1,000,000 and a basis of
$800,000; Asset C had a fair market
value of $500,000 and a basis of
$800,000. X must allocate the exclusion
amount as follows:
Step 1: Determine the built-in gain or
loss of each asset by subtracting the
basis from the FMV of the asset on Date
1.
Basis
Asset A
Asset B
Asset C

200,000
800,000
800,000

FMV
2,000,000
1,000,000
500,000

Built-in Gain/
Loss
1,800,000
200,000
(300,000)

Step 2: Allocate the exclusion
amount to each of the gain properties by
multiplying the exclusion amount
($651,000) by a ratio of the deemed
gain attributable to each gain property
over the total gain of all the gain
properties deemed sold.
Asset A
1,800,000
2,000,000

× 651,000 = 585,900

Asset B
200,000
2,000,000

× 651,000 = 65,100

Step 3: Figure the final amount of
deemed gain on each asset by
subtracting the exclusion amount
allocated to each asset.
Asset A:
Asset B:

1,800,000 − 585,900 = 1,214,100
200,000 − 65,100 = 134,900

Column (f). Complete this column in
order to list the schedule or form on
which you reported the deemed sale of
each property listed in column (a) (for
example, Form 4797 or Form 8949).
Column (g). Complete this column
only for those properties for which you
are electing to defer the payment of tax.

First, complete Section C to line 14. On
a separate attachment, allocate the
amount of tax eligible for deferral among
all gain properties listed on line 8. The
tax attributable to a particular property is
determined by multiplying the amount
on Section C, line 14, by the ratio of the
gain for that property entered on line 8,
column (e), over the total amount of gain
of all gain properties on line 8, column
(e). On line 8, column (g), enter the tax
attributable to each property for which
you are electing to defer tax. Then enter
the total deferred tax for those
properties from line 10, column (g), on
Section C, line 15.
Example. Line 8 lists four assets,
each resulting in a deemed gain in
column (d). The amount of tax eligible
for deferral on Section C, line 14, is
$575,000. You must go back to Section
B, line 8, column (g), to allocate the
deferred tax among the individual
properties.

!

CAUTION

You must attach a computation
to show how you figured the tax
attributable to each property.

See the instructions for Section C
and Notice 2009-85, section 3E, for
more information on deferring the
payment of tax.
Reporting gain or loss. You must
report and recognize the gain (or loss)
of each property reported in line 8,
column (a), on the relevant form or
schedule of your Form 1040 for the part
of the year that includes the day before
your expatriation date. The return to
which you attach your form or schedule
will depend on your status at the end of
the year. See chapter 1 of Pub. 519 to
determine which form you should file.
The gain from column (e) or loss from
column (d) attributable to each property
is reported in the same manner as if the
property had actually been sold. For
example, gain recognized from the
deemed sale of a rental property that
has been depreciated is reported on
Form 4797 as if it had been sold. Gain
recognized from the deemed sale of
personal property (such as stock or a
personal residence) is reported on Form
8949 as if it had been sold. Capital gain
retains its character as capital gain;
ordinary gain retains its character as
ordinary income.

Section C—Deferral of Tax

Use lines 12 through 15 to figure the
amount of tax you can defer. Before
completing lines 12 through 15, you
must fill out two hypothetical individual
income tax returns using Form 1040.
The first return includes all income,
-7-

including the section 877A(a) gain and
loss. The second return includes all
income except the section 877A(a) gain
and loss. Attach both returns to this
Form 8854.

Line 11
If you are not electing to defer the
payment of tax on the gain reported on
line 8, column (e), report on the
appropriate income tax return schedule
or form the gain amount attributable to
each particular property as listed in
line 8, column (e), and report the loss
amount attributable to each particular
property as listed in line 8, column (d). If
you are electing to defer tax, go to
line 12.

Line 12
Enter on line 12 the amount of tax on
line 61 of the first return.

Line 13
Enter on line 13 the amount of tax on
line 61 of the second return.

Line 15
This is the amount of tax you elect to
defer. If you are deferring tax on all
properties, enter the amount from
line 14. If you are electing deferral on
only certain properties, go to Section B,
line 8, column (g), to show how much
deferred tax is allocated to each
property. Attach a computation.
Procedure for deferral of the payment of tax. In order to defer any part
of the mark-to-market tax, you must
enter into a tax deferral agreement with
the IRS and provide adequate security.
Notice 2009-85 contains a sample
agreement (Appendix A). Adequate
security can be either:
1. A bond that is furnished to, and
accepted by, the IRS, that is
conditioned on the payment of tax (and
interest thereon), and that meets the
requirements of section 6325; or
2. Another form of security
(including letters of credit) that is
acceptable to the IRS.
You must contact the following office
in order to make the appropriate
arrangements for providing security.
Internal Revenue Service
SBSE Advisory Office
7850 SW 6th Court
Mail Stop 5780
Plantation, FL 33324-3202
Telephone: (954) 423-7344

You can pay any tax deferred,
together with interest, at any time.
However, the time for the payment of
tax attributable to a particular deferral
asset can be extended only until a) the
year the asset is ultimately disposed of
or b) the year of death.
You must file Form 8854
annually for years up to and
CAUTION
including the year in which the
full amount of deferred tax and interest
is paid.

!

Waiver of treaty benefits. As a
further condition to making the election
to defer the payment of tax on a
particular asset, you must waive any
right under any U.S. tax treaty that
would preclude the assessment or
collection of the tax.
Satisfying your deferred tax liability.
If you entered into an agreement for the
deferral of tax with the IRS Advisory
Office and dispose of one or more
assets for which you elected to defer
tax, you must contact that office to make
arrangements to satisfy your tax liability.
The address for the Advisory Office is
shown above.

Part V—Balance Sheet and
Income Statement

The financial information in Part V is
required under section 6039G.

Who Must Complete
Section 877. If you checked the “Yes”
box in Part II, line 1, you must complete
Part V.
Section 877A. If you expatriated in
2012, you must complete Part V.

Schedule A—Balance Sheet
Note. If there have been significant
changes in your assets and liabilities for
the period that began 5 years before
your expatriation and ended on the date
that you first filed Form 8854, you must
attach a statement explaining the
changes. Also, if you expatriated after
June 3, 2004, and before June 17,
2008, attach a similar statement if you
expect significant changes in the
10-year period after expatriation or
termination of residency.

Columns (a) and (b)
List in U.S. dollars the fair market value
(column (a)) and the U.S. adjusted basis
(column (b)) of your assets and liabilities
as of:

The end of the tax year for which you
are filing this form if your expatriation
date is before June 17, 2008, or
Your expatriation date if you
expatriated on or after June 17, 2008.

trust separately. Include the EIN (if any)
for each trust. Describe the assets and
liabilities (using the categories on this
balance sheet) from your interest in
each trust.

You can use good faith estimates of
fair market value and basis. Formal
appraisals are not required.

Note. To determine if you are an owner
of a trust, see sections 671 through 679.

Column (c)
Subtract the amounts in column (b) from
the amounts in column (a) and show the
gain or (loss) in column (c). Enter
negative amounts in parentheses.

Column (d)
If you are a former U.S. LTR, it may
benefit you to complete column (d). For
more details, see section 877(e)(3)(B)
or section 877A(h)(2). Only former U.S.
LTRs should complete column (d).
Enter in column (d) the fair market
value of each asset on the date you first
became a U.S. resident for tax
purposes.
Note. The date you first became a U.S.
resident for tax purposes is not always
the same as the date you first became a
U.S. lawful permanent resident. For
details on U.S. residency (including the
substantial presence test), see Pub.
519.

Line 5a
List the appropriate amount in each
column for all nonmarketable stock and
securities issued by foreign
corporations that would be controlled
foreign corporations if you were still a
U.S. citizen or resident. Note that these
amounts are already included on line 5.
Do not include amounts on this line in
the total on line 20.

Line 8
List the total value of all your partnership
interests. If you hold an interest in one
or more partnerships, you must attach a
statement to Form 8854 that lists each
partnership separately. Include the
employer identification number (EIN), if
any, for each partnership. Describe the
assets and liabilities (using the
categories on this balance sheet) from
your interest in each partnership.

Line 9
List the total value of all assets held by
trusts that you are considered to own for
tax purposes. You must attach a
statement to Form 8854 that lists each
-8-

Line 10
List the total value of all assets held by
nongrantor trusts in which you are
considered to have a beneficial interest.
You must attach a statement to Form
8854 that lists each trust separately.
Include the EIN (if any) for each trust.
Describe the assets and liabilities (using
the categories on this balance sheet)
from your interest in each trust.
Note. To determine if you are a
beneficiary of a nongrantor trust, you
must allocate the property interests of
the trust based on all relevant facts and
circumstances. To determine the value
of your beneficial interest, use the
valuation principles under section 2512.
See Section III of Notice 97-19 for
examples of how the property interests
of a nongrantor trust should be allocated
to the beneficiaries of the trust.

Lines 11 and 12
Intangible property includes any of the
following items that have substantial
value independent of the services of any
individual.
Patent, invention, formula, process,
design, pattern, or know-how.
Copyright, literary, musical, or artistic
composition.
Trademark, trade name, or brand
name.
Franchise, license, or contract.
Method, program, system,
procedure, campaign, survey, study,
forecast, estimate, customer list, or
technical data.
Any similar item.

Line 19
Attach a statement describing and
listing the total value of any other assets
you have that are not included on lines 1
through 18.

Line 20
Combine lines 1 through 5 and 6
through 19, not including any amounts
on line 5a. The amounts on line 5a are
included in determining the amounts on
line 5.

Line 23

Line 1

Attach a statement describing and
listing the total value of any other
liabilities you have that are not included
on lines 21 and 22.

Include all U.S. source gross income
that is not effectively connected with the
conduct of a U.S. trade or business on
lines 1a through 1e.

Schedule B–Income Statement

Schedule B is required to satisfy the
requirements of section 6039G(b)(5).
You must complete Schedule B without
regard to whether you have income
subject to tax under section 877 or
section 877A for the tax year.
If your expatriation date is before
June 17, 2008, provide income
information for the tax year for which
you are filing Form 8854.
If your expatriation date is after June
16, 2008, provide income information
for the part of the tax year that ends with
the day before your expatriation date,
but enter zero on lines 5, 6, and 7.
Note. If you are subject to section 877
for all or a part of the tax year, and you
have income subject to tax under
section 877 for the tax year, you are
liable for tax on that income as provided
in section 1 or section 55, if the tax
figured under such sections exceeds
the tax that would be imposed on you
under section 871. In most cases, this
means that you must report all income
subject to tax under section 877 on
Form 1040NR, whether or not it is
effectively connected with the conduct
of a trade or business in the United
States, and you are not permitted to
exclude certain types of income, such
as portfolio interest or capital gains,
which normally would be exempt from
tax in the hands of a nonresident alien.
Treaty residents. Most U.S. tax
treaties do not prevent the United States
from continuing to tax former citizens
and former LTRs under domestic law.
Unless the treaty prevents it, you will be
subject to the rules of section 877.
If you deferred the payment of tax
under section 877A(b), you waived any
right under a treaty that would prevent
assessment or collection of any tax
imposed because of section 877A. If
you are a covered expatriate (see
Covered expatriate, earlier) and had
eligible deferred compensation items or
an interest in a nongrantor trust as of the
day before your expatriation date, you
waived any right under a treaty that
would reduce the rate of withholding tax
on the payment of such income item or
trust distribution, unless you elected to
be treated as receiving the value of your
entire interest in a nongrantor trust as of
the day before your expatriation date.

Lines 3 Through 6
Lines 3 through 6 require reporting
income that, but for the application of
section 877(d), would be income from
sources outside the United States. If
you report income on these lines, you
also must report this income as taxable
income on Form 1040NR.

Line 5
If you owned (within the meaning of
section 958(a) or (b)) at any time during
the 2-year period ending on the date of
your expatriation, more than 50% of the
vote or value of a foreign corporation,
income or gain you receive from the
foreign corporation during the tax year
will be treated as from sources within
the United States, to the extent such
income or gain is not more than the
earnings and profits from such stock
that were earned or accumulated before
the date of your expatriation while such
ownership requirements were met.

Line 6
If, during the current tax year, you
exchanged any property and (a) the
gain would not (but for this paragraph)
be recognized on such exchange in
whole or in part, (b) income derived
from such property was from sources
within the United States (or, if no income
was so derived, would have been from
such sources), and (c) income derived
from the property acquired in the
exchange would be from sources
outside the United States, then the
property will be treated as sold for its fair
market value on the date of the
exchange, in accordance with Section V
of Notice 97-19. The removal of
appreciated property with an aggregate
fair market value in excess of $250,000
from the United States is an exchange
of property covered by this provision.
Enter on line 6 the total amount of
gain resulting from any such exchanges
during the tax year and, if you have
elected to enter into a gain recognition
agreement with the IRS deferring the
gain, attach a copy of the agreement to
your Form 1040NR. If you dispose of
any property covered by a gain
recognition agreement during the tax
year, also list the gain realized on this
line. See Section V of Notice 97-19 for
-9-

additional information on exchanges
and gain recognition agreements.

Line 7
If, during the 10-year period beginning
on the date of your expatriation, or
during the 5-year period before your
expatriation, you contributed
U.S.-source property to a foreign
corporation that would be a controlled
foreign corporation had you remained a
U.S. citizen or LTR, any income or gain
on that property received or accrued by
the foreign corporation during the tax
year is treated as received or accrued
by you. See Section VI of Notice 97-19
for additional information.

Line 8
Add lines 1f through 7 to report your
total income from U.S. sources.

Line 9
List the total amount of all other income
or gain for the tax year.

Penalties
If you are subject to section 877 or
section 877A and required to file Form
8854 for any tax year, and you fail to file
or do not include all the information
required by the form or the form
includes incorrect information, you will
owe a penalty of $10,000 for that year,
unless it is shown that such failure is
due to reasonable cause and not willful
neglect.

Signature

Form 8854 is not considered valid
unless you sign it. If you have someone
else prepare Form 8854, you are still
responsible for its correctness.

Paid preparers. Generally, anyone
you pay to prepare Form 8854 must
sign it and include their preparer tax
identification number (PTIN) in the
space provided. The preparer must give
you a copy for your records. Someone
who prepares Form 8854 but does not
charge you a fee should not sign it.
Paperwork Reduction Act Notice.
We ask for the information on this form
to carry out the Internal Revenue laws of
the United States. You are required to
give us the information. We need it to
ensure that you are complying with
these laws and to allow us to figure and
collect the right amount of tax.
You are not required to provide the
information requested on a form that is
subject to the Paperwork Reduction Act

unless the form displays a valid OMB
control number. Books or records
relating to a form or its instructions must
be retained as long as their contents
may become material in the
administration of any Internal Revenue

law. Generally, tax returns and return
information are confidential, as required
by section 6103.
The average time and expenses
required to complete and file this form

-10-

will vary depending on individual
circumstances. For the estimated
averages, see the instructions for your
income tax return.