Form 4563 (Revised December 2005) Exclusion of Income for Bona Fide Residents of American Samoa. Summary: This is an example of Form 4563 (Revised December 2005) with items included as described in the text. Additionally,
these line items
are completed:
|
“Name(s) shown on Form 1040” field contains John Black
|
|
“Your social security number” field contains 111-00-1111
|
