Form 2555-EZ Foreign Earned Income Exclusion 2005. Summary: This is an example of Form 2555-EZ (2005) with items included as described in the text. Additionally, the following
line items are
completed:
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“Name shown on Form 1040” field contains Judith E. Adams
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“Your social security number” field contains 222-00-2222
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Under
“Part I: Tests To See If You Can Take the Foreign Earned Income Exclusion”:
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1. Bona Fide Residence Test
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“a. Were you a bona fide resident of a foreign country or countries for a period that includes an entire tax year (see page
2 of the
instructions)? No” checkbox checked
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2. Physical Presence Test
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“a. Were you physically present in a foreign country or countries for at least 330 full days during 2004 or any other period
of 12 months in a
row starting or ending in 2004? Yes” checkbox checked
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“b. The physical presence test is based on the 12-month period from” field contains 1-1-04 through 12-31-04
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“3. Tax Home Test. Was your tax home in a foreign country or countries throughout your period of bona fide residence or physical
presence,
whichever applies? Yes” checkbox checked
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Under
“Part II: General Information”:
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“4. Your foreign address (including country)” field contains
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“5. Your occupation” field contains Secretary
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“6. Employer's name” field contains A B Insurance Company, Incorporated
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“7. Employer's United States address (including ZIP code)” field contains
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2645 Pewter Place
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Anytown, Anystate, United States of America
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“8. Employer's foreign address” field contains
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“9. Employer is (check any that apply): a. A United States business” checkbox checked
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“10a. If you filed Form 2555 or 2555-EZ after 1981, enter the last year you filed the form.” field contains 2003
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“10c. Have you ever revoked the foreign earned income exclusion? No” checkbox checked
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“11a. List your tax home(s) during 2005 and date(s) established.” field contains Country Y 6-1-98
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“11b. Of what country are you a citizen/national?” field contains United States
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Under
“Part IV: Figure Your Foreign Earned Income Exclusion”:
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“14. Enter the number of days in your qualifying period that fall within 2004” field contains 366 days
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“15. Did you enter 365 on line 14? Yes” checkbox checked
“Enter 1.000” field contains 1.000
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“16. Multiply line 13 by line 15” field contains 80,000
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