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

Caution: DRAFT—NOT FOR FILING
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Form

1040-NR

Department of the Treasury
Internal Revenue Service

▶ Go

U.S. Nonresident Alien Income Tax Return

beginning

For the year January 1–December 31, 2019, or other tax year
, 2019, and ending

Your first name and middle initial

2019

, 20

Identifying number (see instructions)

Last name

Present home address (number and street or rural route). If you have a P.O. box, see instructions.

Apt. no.

Check if:

Individual

DRAFT AS OF
July 11, 2019
DO NOT FILE

Please print
or type

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

Filing
Status

OMB No. 1545-0074

to www.irs.gov/Form1040NR for instructions and the latest information.

Check only
one box.

Dependents

1
2
3

Reserved
Single nonresident alien
Reserved

7

Dependents: (see instructions)

If more
than four
dependents,
see instructions
and check
here.

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.

Adjusted
Gross
Income

Foreign province/state/county

(1) First name

Last name

Reserved
Married nonresident alien
Qualifying widow(er) (see instructions)
Child’s name ▶

4
5
6

(2) Dependent’s
identifying number

(4) ✔ if qualifies for (see instr.):

(3) Dependent’s
relationship to you

Child tax credit

8 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . .
9a Taxable interest . . . . . . . . . . . . . . . . . . . . . . . . .
b Tax-exempt interest. Do not include on line 9a . . . . . . .
9b
10a Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . .
b Qualified dividends (see instructions) . . . . . . . . . .
10b
11 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) . . .
12 Scholarship and fellowship grants. Attach Form(s) 1042-S or required statement (see instructions)
13 Business income or (loss). Attach Schedule C (Form 1040 or 1040-SR)
. . . . . . .
14 Capital gain or (loss). Attach Schedule D (Form 1040 or 1040-SR) if required. If not required, check here
15 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . .
16a IRA distributions
. . . . .
16a
16b Taxable amount (see instr.)
17a Pensions and annuities
. . .
17a
17b Taxable amount (see instr.)
18 Rental real estate, royalties, partnerships, trusts, etc. Attach Schedule E (Form 1040 or 1040-SR)
19 Farm income or (loss). Attach Schedule F (Form 1040 or 1040-SR) . . . . . . . . .
20 Unemployment compensation . . . . . . . . . . . . . . . . . . . .
21 Other income. List type and amount (see instructions)
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 . . . . . . . . . . . . . . . . . . . ▶
24 Educator expenses (see instructions) . . . . . .
25 Health savings account deduction. Attach Form 8889 .
26 Moving expenses for members of the Armed Forces.
3903 . . . . . . . . . . . . . . . .

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Attach
. .

27
28
29
30
31
32
33
. . .
. . .

Self-employed SEP, SIMPLE, and qualified plans . . .
Self-employed health insurance deduction (see instructions)
Penalty on early withdrawal of savings . . . . . . .
Scholarship and fellowship grants excluded . . . . .
IRA deduction (see instructions) . . . . . . . . .
Student loan interest deduction (see instructions) . . .
Add lines 24 through 33 . . . . . . . . . . .
Adjusted Gross Income. Subtract line 34 from line 23
.

36
37
38
39

Reserved for future use . . . . . . . . . . . . . . .
Itemized deductions from page 3, Schedule A, line 8 . . . . . .
Qualified business income deduction. Attach Form 8995 or Form 8995-A
Exemptions for estates and trusts only (see instructions) . . . . .

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

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8
9a

10a

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

23

26

28
29
30
31
32
33
34
35

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Credit for other dependents

24
25

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Form
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27 Deductible part of self-employment tax. Attach Schedule SE (Form
1040 or 1040-SR) . . . . . . . . . . . . . . . .

Tax and
Credits

Foreign postal code

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Cat. No. 11364D

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34
35
36
37
38
39

Form 1040-NR (2019)

Page 2

Form 1040-NR (2019)

Tax and
Credits
(continued)

40
41
42
43
44
45
46
47
48
49
50
51
52
53
54

Add lines 37 through 39 . . . . . . . . . . . . . . . . . .
Taxable income. Subtract line 40 from line 35. If zero or less, enter -0- . . .
Tax (see instr.). Check if any is from Form(s):
a
8814
b
4972
c
Alternative minimum tax (see instructions). Attach Form 6251 . . . . . .
Excess advance premium tax credit repayment. Attach Form 8962 . . . . .
Add lines 42, 43, and 44 . . . . . . . . . . . . . . . . . .
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 and credit for other dependents (see instructions) .
49
Residential energy credit. Attach Form 5695 . . . . . . . .
50
Other credits from Form:
a
3800 b
8801 c
51
Add lines 46 through 51. These are your total credits . . . . . . . . .
Subtract line 52 from line 45. If zero or less, enter -0- . . . . . . . . .
Tax on income not effectively connected with a U.S. trade or business from page
NEC, line 15 . . . . . . . . . . . . . . . . . . . . . .

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40
41
42
43
44
45

DRAFT AS OF
July 11, 2019
DO NOT FILE

Other
Taxes

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4,
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Schedule
. . .

55 Self-employment tax. Attach Schedule SE (Form 1040 or 1040-SR) . . . . . . . . .
56 Unreported social security and Medicare tax from Form:
a
4137
b 8919
57 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . .
58 Transportation tax (see instructions)
. . . . . . . . . . . . . . . . . .
59a Household employment taxes from Schedule H (Form 1040 or 1040-SR) . . . . . . .
b Repayment of first-time homebuyer credit from Form 5405. Attach Form 5405 if required . .
60 Taxes from:
Form 8959 b
Instructions; enter code(s)
a
61 Total tax. Add lines 53 through 60 . . . . . . . . . . . . . . . . . . ▶
62 Federal income tax withheld from:
Payments
a Form(s) W-2 and 1099 . . . . . . . . . . . . . . .
62a
b Form(s) 8805 . . . . . . . . . . . . . . . . . .
62b
c Form(s) 8288-A . . . . . . . . . . . . . . . . .
62c
d Form(s) 1042-S . . . . . . . . . . . . . . . . .
62d
63 2019 estimated tax payments and amount applied from 2018 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 RRTA tax withheld (see instructions)
67
68 Credit for federal tax on fuels. Attach Form 4136
. . . . . .
68
69 Credits from Form: a 2439 b
Reserved c
8885 d
69
70 Credit for amount paid with Form 1040-C . . . . . . . . .
70
71 Add lines 62a through 70. These are your total payments
. . . . . . . . . . ▶
72 If line 71 is more than line 61, subtract line 61 from line 71. This is the amount you overpaid
Refund
73a Amount of line 72 you want refunded to you. If Form 8888 is attached, check here . . ▶
Direct deposit?
▶
c Type:
b Routing number
Checking
Savings
See
d Account number
instructions.
e If you want your refund check mailed to an address outside the United States not shown on page 1, enter it here.
74 Amount of line 72 you want applied to your 2020 estimated tax .

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52
53

54
55
56
57
58
59a
59b
60
61

71
72
73a

74

Amount
75 Amount you owe. Subtract line 71 from line 61. For details on how to pay, see instructions . ▶
75
You Owe
76
76 Estimated tax penalty (see instructions) . . . . . . . . .
Yes. Complete below.
Third Party Do you want to allow another person to discuss this return with the IRS? See instructions
Phone
Personal identification
Designee
▶
▶
no. ▶
Sign Here

Paid
Preparer
Use Only

Designee’s name
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

▲

Keep a copy of
this return for
your records.

No

Print/Type preparer’s name

Firm’s name ▶
Firm’s address

Preparer’s signature

Date

If the IRS sent you an Identity
Protection PIN, enter it here
(see instr.)

Check
if
self-employed

PTIN

Firm’s EIN ▶
▶

Phone no.
Form 1040-NR (2019)

Page 3

Form 1040-NR (2019)

Schedule A—Itemized Deductions (see instructions)
Taxes You
Paid

1

07

State and local income taxes

DRAFT AS OF
July 11, 2019
DO NOT FILE

Gifts
to U.S.
Charities

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

Casualty
and Theft
Losses

Other
Itemized
Deductions

State and local income taxes .

b

Enter the smaller of line 1a and $10,000 ($5,000 if box 5 is checked) .
Gifts by cash or check. If you made any gift of $250 or more, see
instructions
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2

a

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1a
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2

Other than by cash or check. If you made any gift of $250 or more,
see instructions. Individuals must attach Form 8283 if line 3 is over
$500 . . . . . . . . . . . . . . . . . . . .

3

4

Carryover from prior year

4

5
6

Add lines 2 through 4 . . . . . . . . . . . . . . . . . . . . . .
Casualty and theft loss(es) from a federally declared disaster (other than net qualified
disaster losses). Attach Form 4684 and enter the amount from line 18 of that form. See
instructions . . . . . . . . . . . . . . . . . . . . . . . . . .
Other—from list in instructions. List type and amount ▶

3

7

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1b

5

6

7

Total
Itemized
Deductions

8

Add the amounts in the far right column for lines 1b through 7. Also, enter this amount on
Form 1040-NR, line 37 . . . . . . . . . . . . . . . . . . . . . .

8

Form 1040-NR (2019)

DRAFT AS OF
July 11, 2019
DO NOT FILE

Form 1040-NR (2019)

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

1
a
b
c
2
a
b
c
3
4
5
6
7
8
9
10
a
b
11
12
13
14
15

(a) 10%

Dividends and dividend equivalents:
Dividends paid by U.S. corporations
. . . . . . . . . . . . .
Dividends paid by foreign corporations . . . . . . . . . . . . .
Dividend equivalent payments received with respect to section 871(m)
transactions . . . . . . . . . . . . . . . . . . . . .
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) ▶

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(b) 15%

(d) Other (specify)

(c) 30%

%

%

1a
1b
1c

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

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10c

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11

12
Add lines 1a through 12 in columns (a) through (d) . . . . . . . . .
13
Multiply line 13 by rate of tax at top of each column . . . . . . . .
14
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
1040-NR, line 54 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

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 or 1040-SR).
Report
property
sales
or
exchanges that are effectively
connected with a U.S. business
on Schedule D (Form 1040 or
1040-SR), Form 4797, or both.

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.)

(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
. . . . . . . . . . . . . . . . . . . . . . .
17 (
18 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 1040-NR (2019)

Page 5

Form 1040-NR (2019)

Schedule OI—Other Information (see instructions)
Answer all questions

A
B
C
D

Of what country or countries were you a citizen or national during the tax year?
In what country did you claim residence for tax purposes during the tax year?
Have you ever applied to be a green card holder (lawful permanent resident) of the United States?
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, 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,
immigration status on the last day of the tax year.
F

G

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Yes

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DRAFT AS OF
July 11, 2019
DO NOT FILE
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Date departed United States
mm/dd/yy

Date entered United States
mm/dd/yy

Give number of days (including vacation, nonworkdays, and partial days) you were present in the United States during:
2017
, 2018
, and 2019
.

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 . . . ▶
Are you filing a return for a trust? . . . . . . . . . . . .
If “Yes,” did the trust have a U.S. or foreign owner under the grantor
U.S. person, or receive a contribution from a U.S. person? . . . .

K
L

No
No

Yes

No

Date departed United States
mm/dd/yy

H

J

Yes
Yes

enter your U.S.

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. ▶
List all dates you entered and left the United States during 2019. 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
mm/dd/yy

No

.

Yes

No

. . . . . . . . . . . . . .
trust rules, make a distribution or loan to a
. . . . . . . . . . . . . .

Yes

No

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Yes
No
Did you receive total compensation of $250,000 or more during the tax year? . . . . . . . . . . . .
Yes
No
If “Yes,” did you use an alternative method to determine the source of this compensation?
. . . . . . .
Yes
No
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 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 1040-NR, 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? . . . . . . . .
Yes
No
3. Are you claiming treaty benefits pursuant to a Competent Authority determination? . . . . . . . . . .
Yes
No
If “Yes,” attach a copy of the Competent Authority determination letter to your return.
M
Check the applicable box if:
1. This is the first year you are making an election to treat income from real property located in the United States as effectively connected
with a U.S. trade or business under section 871(d). See instructions . . . . . . . . . . . . . . . . . . ▶

2. You have made an election in a previous year that has not been revoked, to treat income from real property located in the United
States as effectively connected with a U.S. trade or business under section 871(d). See instructions . . . . . . . . ▶
Form 1040-NR (2019)