Federal Free Printable 2016 Form 8854 for 2017 Federal Initial and Annual Expatriation Statement

It appears you don't have a PDF plugin for this browser. Please use the link below to download 2016-federal-form-8854.pdf, and you can print it directly from your computer.

Initial and Annual Expatriation Statement
2016 Form 8854

Form 8854 Initial and Annual Expatriation Statement For calendar year 2016 or other tax year beginning Department of the Treasury Internal Revenue Service ▶ OMB No. 1545-0074 , 2016, and ending , 20 Information about Form 8854 and its separate instructions is at www.irs.gov/form8854. ▶ Please print or type. Name 2016 Attachment Sequence No. 112 Identifying number (see instructions) Part I General Information. For all filers. 1 Mailing address and telephone number where you can be reached after expatriation 2 Address of principal foreign residence (if different from line 1) 3 Country of tax residence (if different from line 2) 4 Expatriation date. Check the box that applies (see instructions). June 4, 2004 – June 16, 2008. Complete Parts II and V June 17, 2008 – December 31, 2015. Complete Part III if: • You made an election to defer the payment of tax on a prior year Form 8854, • You have an item of eligible deferred compensation, or • You have an interest in a nongrantor trust. Otherwise, you don't need to file Form 8854. January 1, 2016 – December 31, 2016. Complete Parts IV and V 5 Date of notification of expatriating act, termination of residency, or claim of treaty benefits (see instructions). Citizen. Date notification given to Department of State Long-term resident. Date notification given to Department of Homeland Security Long-term resident with dual residency in a treaty country. Date commencing to be treated, for tax purposes, as a resident of the treaty country 6 Number of days you were physically present in the United States in the current year 7 List all countries (other than the United States) of which you are a citizen. a Name of country b Date you became a citizen of each country listed in line 7a 8 How you became a U.S. citizen Part II 1 By birth By naturalization For Persons Who Expatriated After June 3, 2004, and Before June 17, 2008 Did you complete Form 8854 for any period after June 3, 2004, and before June 17, 2008? No. If you expatriated for immigration purposes after June 3, 2004, and before June 17, 2008, but have not previously filed a Form 8854, you continue to be treated as a U.S. citizen or U.S. lawful permanent resident for U.S. income tax purposes until the day that you file this form. Because you didn't file Form 8854 for the year of expatriation for immigration purposes, you are subject to the alternative tax in section 877(b) for the 10-year period beginning on the date that you file this form (see instructions). Yes. Tax year for which Form 8854 first filed 2 a . Go to line 2. Were you physically present in the United States for more than 30 days but not more than 60 days during the tax year? . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No If you checked “Yes” to line 2, were you performing services for an unrelated employer? Yes No Yes No . . . . b If you checked “Yes” to line 2a, are you a citizen or resident, fully liable for income tax, in the country in which you were born, your spouse was born, or either of your parents was born? . . . . . . . Next: Go to Part V. For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 24126N Form 8854 (2016) Form 8854 (2016) Part III Page 2 For Persons Who Expatriated After June 16, 2008, and Before January 1, 2016 • If you made an election to defer the payment of tax, complete line 1. • If you have an item of eligible deferred compensation, complete line 2. • If you have an interest in a nongrantor trust, complete line 3. 1 Complete columns (a), (b), and (c) for all property on which you deferred tax on a prior year Form 8854. Complete column (d) for any property you disposed of in 2016 and see the instructions for Part III. (a) Description of property (b) Amount of mark-to-market gain or (loss) reported on prior year Form 8854 (c) Amount of tax deferred on prior year Form 8854 (d) Date of disposition (if any) 2 Did you receive any distributions of eligible deferred compensation items for 2016? If “Yes,” Amount of distribution: Amount withheld at source, if any: Yes No 3 Did you receive any distributions from a nongrantor trust for 2016? If “Yes,” Amount of distribution: Amount withheld at source, if any: Yes No Part IV For Persons Who Expatriated During 2016 Section A Expatriation Information 1 Enter your U.S. income tax liability (after foreign tax credits) for the 5 tax years ending before the date of expatriation. 1st Year Before Expatriation $ 2nd Year Before Expatriation $ 3rd Year Before Expatriation 4th Year Before Expatriation $ 5th Year Before Expatriation $ $ 2 Enter your net worth on the date of your expatriation for tax purposes . 3 Did you become at birth a U.S. citizen and a citizen of another country, and do you continue to be a citizen of, and taxed as a resident of, that other country? . . . . . . . . . . . . . . . . . . . Yes No If you answered “Yes” to question 3, have you been a resident of the United States for not more than 10 of the last 15 tax years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Were you under age 181/2 on the date you expatriated and have you been a U.S. resident for not more than 10 years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No Do you certify under penalties of perjury that you have complied with all of your tax obligations for the 5 preceding tax years (see instructions)? . . . . . . . . . . . . . . . . . . . . . . . Yes No 4 5 6 . . . . . . . . . $ Form 8854 (2016) Page 3 Form 8854 (2016) Section B Property Owned on Date of Expatriation Don't complete Section B if: • Your average net income tax liability for the 5 tax years immediately before expatriation (see line 1 in Section A) wasn't more than $161,000, your net worth (see line 2 in Section A) was under $2 million, and you checked “Yes” on line 6 in Section A; • In Section A, you checked “Yes” on lines 3, 4, and 6; or • In Section A, you checked “Yes” on lines 5 and 6. 7a Do you have any eligible deferred compensation items? Checking the “Yes” box is an irrevocable waiver of any right to claim any reduction in withholding for such eligible deferred compensation item under any treaty with the United States . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No b Do you have any ineligible deferred compensation items? If “Yes,” you must include in income the present value of your account on the day before your expatriation date . . . . . . . . . . . . Yes No Do you have any specified tax deferred accounts? If “Yes,” you must include in income the entire account balance on the day before your expatriation date . . . . . . . . . . . . . . . . . Yes No d Do you have an interest in a nongrantor trust? Checking the “Yes” box is a waiver of any right to claim any reduction in withholding on any distribution from such trust under any treaty with the United States unless you make the election below . . . . . . . . . . . . . . . . . . . . . . . . Yes No c Check this box to elect under section 877A(f)(4)(B) to be treated as having received the value of your entire interest in the trust (as determined for purposes of section 877A) as of the day before your expatriation date. Attach a copy of your valuation letter ruling issued by the IRS (see instructions). 8 Recognition of gain or loss on the deemed sale of mark-to-market property. Caution. Don't include in column (a) any property described on line 7a, 7b, 7c, or 7d. Complete column (g) only if you are deferring tax on gain from any property listed in column (a). (a) Description of property (b) Fair market value on day before date of expatriation (c) Cost or other basis* (d) Gain or (loss). Subtract (c) from (b) (e) Gain after allocation of the exclusion amount (see instructions) (f) Form or Schedule on which gain or loss is reported (g) Amount of tax deferred (attach computations) 9 Total. Add the amounts in column (d) and column (e) . . . 10 Total tax deferred. Add the amounts in column (g). Enter here and on line 15 . . . . . . . . . . . . . . *You must identify as “(h)(2)” any property for which you are making the special basis election under section 877A(h)(2). This election is irrevocable. See the instructions for Part IV, Section B, line 8, column (c). Form 8854 (2016) Form 8854 (2016) Page 4 Section C Deferral of Tax Election to defer tax. You can defer tax only if you have provided adequate security. Adequate security is described in the instructions. 11 Are you electing to defer tax under section 877A(b)? Checking the “Yes” box is an irrevocable waiver of any right under any treaty of the United States that would prevent assessment or collection of any tax imposed because of section 877A. Yes No If you checked the “Yes” box, continue to line 12. Otherwise, don't complete lines 12 through 15. 12 Enter the total tax you would have reported on Form 1040, line 63, for the part of the year including the day before the expatriation date absent the deferral election . . . . . . . . 12 Enter the total tax for the same part of the tax year determined without regard to the amounts attributable to section 877A(a). Attach computation . . . . . . . . . . . . . . . . 13 14 Subtract line 13 from line 12. This is the amount of tax eligible for deferral . . . . . . . 14 15 Enter the total tax deferred from line 10, column (g) . . . . . . . . 15 13 . . . . . . . . • If you are filing Form 1040, enter this amount in brackets to the left of the entry space for line 63. Identify as “EXP.” • If you are filing Form 1040NR, enter this amount in brackets to the left of the entry space for line 61. Identify as “EXP.” Form 8854 (2016) Page 5 Form 8854 (2016) Part V Balance Sheet and Income Statement Schedule A Balance Sheet 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 following date. • Part II filers - the end of the tax year for which you are filing the form • Part IV filers - your expatriation date. Note: Part IV filers don't complete column (d). For more details, see the separate instructions. Assets 1 2 (a) Fair market value (FMV) (b) U.S. adjusted basis (c) Gain or (loss). Subtract column (b) from column (a) (d) FMV on beginning date of U.S. residency (optional, for long-term residents only) Cash, including bank deposits . . . . . Marketable stock and securities issued by U.S. companies . . . . . . . . . . Marketable stock and securities issued by foreign companies . . . . . . . . . Nonmarketable stock and securities issued by U.S. companies . . . . . . . . . Nonmarketable stock and securities issued by foreign companies . . . . . . . . 3 4 5 a Separately state stock issued by foreign companies that would be controlled foreign corporations if you were still a U.S. citizen or permanent resident (see instructions) . . . b Provide the name, address, and EIN, if any, of any such company 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Pensions from services performed in the United States . . . . . . . . . . Pensions from services performed outside the United States . . . . . . . . . Partnership interests (see instructions) . . Assets held by trusts you own under sections 671 through 679 (see instructions) Beneficial interests in nongrantor trusts (see instructions) . . . . . . . . . . . Intangibles used in the United States . . . Intangibles used outside the United States . Loans to U.S. persons . . . . . . . Loans to foreign persons . . . . . . . Real property located in the United States . Real property located outside the United States . Business property located in the United States . . . . . . . . . . . . . Business property located outside the United States . . . . . . . . . . Other assets (see instructions) . . . . . . Total assets. Add lines 1 through 5 and lines 6 through 19. Don't include amounts on line 5a in this total . . . . . . . . . . Liabilities Installment obligations . . . . . . . Mortgages, etc. . . . . . . . . . . Other liabilities (see instructions) . . . . Total liabilities. Add lines 21 through 23 . . Net worth. Subtract line 24 from line 20, column (a) . . . . . . . . . . . . Amount Form 8854 (2016) Page 6 Form 8854 (2016) Income Statement Schedule B Provide income information for the following period. • Part II filers - the tax year for which you are filing the form • Part IV filers - the part of the tax year that ends with the day before your expatriation date; but enter -0- for lines 5 through 7. 1 U.S. source gross income not effectively connected with the conduct of a U.S. trade or business. 1a a Interest . . . . . . . . . . . . . . . . . . . . b Dividends . . . . . . . . . . . . . . . . . . . . 1b c Royalties . . . . . . . . . . . . . . . . . . . . 1c d Pension distributions . . . . . . . . . . . . . . . . 1d e Other . . . . . . . . . . . . . . . . . . . . . 1e f Total. Add lines a through e . . . . . . . . . . . . . . . . . . . . . . . 1f 2 Gross income that is effectively connected with the conduct of a U.S. trade or business . . . 2 3 Income from the performance of services in the United States . . . . . . . . . . . 3 4 Gains from the sale or exchange of: a Property (other than stock or debt obligations) located in the United States . . . . . . . . . . . . . . . . . . . . . 4a b Stock issued by a U.S. domestic corporation . . . . . . . . 4b c Debt obligations of U.S. persons or of the United States, a state or political subdivision thereof, or the District of Columbia . . . . . 4c d Total. Add lines a through c . . . . . . . . . . . . . . . . . . . . . . . 4d 5 Income or gain derived from certain foreign corporations to the extent of your share of earnings and profits earned or accumulated before the date of expatriation (see instructions) . . . . 5 6 Gains on certain exchanges of property that ordinarily wouldn't be recognized (see instructions) 6 7 Income received or accrued by certain foreign corporations (see instructions) . . . . . . 7 8 Add lines 1f, 2, 3, 4d, 5, 6, and 7 . . . . . . . . . . . . . . . . . . . . . 8 9 Gross income from all other sources . . . . . . . . . . . . . . . . . . . . 9 10 Total. Add lines 8 and 9 . . . . . . . . . . . . . . . . . . . . . . . . 10 Sign Here Paid Preparer Use Only Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than filer) is based on all information of which preparer has any knowledge. Your signature Print/Type preparer’s name Firm’s name ▶ Firm’s address ▶ Date Preparer’s signature Date Check if self-employed PTIN Firm's EIN ▶ Phone no. Form 8854 (2016)
Extracted from PDF file 2016-federal-form-8854.pdf, last modified November 2016

More about the Federal Form 8854 Other TY 2016

We last updated the Initial and Annual Expatriation Statement in May 2017, so this is the latest version of Form 8854, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 8854 directly from TaxFormFinder. You can print other Federal tax forms here.

Other Federal Other Forms:

TaxFormFinder has an additional 774 Federal income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form 8962 Premium Tax Credit
Form 12277 Application for Withdrawal of Filed Form 668(Y), Notice of Federal Tax Lien (Internal Revenue Code Section 6323(j))
Form W-4V Voluntary Withholding Request
Form 433-D Installment Agreement
Form 8283 Noncash Charitable Contributions

Download all  tax forms View all 775 Federal Income Tax Forms


Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 8854 from the Internal Revenue Service in May 2017.

Show Sources >

Historical Past-Year Versions of Federal Form 8854

We have a total of six past-year versions of Form 8854 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form 8854

2016 Form 8854

Initial and Annual Expatriation Statement 2015 Form 8854

2015 Form 8854

Initial and Annual Expatriation Statement 2014 Form 8854

2014 Form 8854

Initial and Annual Expatriation Statement 2013 Form 8854

2013 Form 8854

Initial and Annual Expatriation Statement 2012 Form 8854

2012 Form 8854

Initial and Annual Expatriation Statement 2011 Form 8854

2011 Form 8854


TaxFormFinder Disclaimer:

While we do our best to keep our list of Federal Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.

** This Document Provided By TaxFormFinder.org **
Source: http://www.taxformfinder.org/federal/form-8854