12 expat questionnaire final pdf fill in version
TRANSCRIPT
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EXPATRIATETAXQUESTIONNAIREFORU.S.CITIZENSLIVINGABROAD
DonD.Nelson,CPA,Attorney/CharlesKauffman,CPA/KauffmanNelsonLLP
ThisquestionnairecanbefilledoutbyhandorinAdobeReader8.0orhigher
Indicateyearthisformiscompletedfor ifnot2012:__________________________________________
PrimaryTaxpayer
Spouse
(write
N/A
ifnot
married)
Name ____________________________ __________________________
SocialSecurityNumber ____________________________ __________________________
DateofBirth ____________________________ __________________________
Profession ____________________________ __________________________
CitizenshipCountry ____________________________ __________________________
U.S.GreenCardHolder? ____________________________ __________________________Indicate
ifGreen
Card
obtained
or
relinquished
this
year
and
date
DidyoufileajointU.S.returnwithyourspouselastyear? _____Yes_____No_____N/A
Didyourmaritalstatuschangethisyear? _____Yes_____No_____N/A
IndicateanyU.S.Stateswhereyoufiledataxreturnlastyear: __________________________
MightyouberequiredtofileataxreturnwithaUSstateaswell? ____Yes____No_____Dontknow
PleaseExplain._______________________________________________________________
ContactInformation
EmailAddress(es) _________________________________________________________
PhoneNumbers
(indicate
home,
office,ormobile) _________________________________________________________
ResidenceAddressinForeignCountry______________________________________________________
MailingAddresstobeshownon
TaxReturn _________________________________________________________If aU.S.address,pleaseindicatec/oandNameifmailisgoingtosomeoneelse
Besttimeormethodtocontact _________________________________________________________
DependentChildrensNames,GenderofChild,DatesofBirth,andSocialSecurityNumbers:
PleasenoteifyourchildrenarenotU.S.citizensandtheircountryofcitizenship. Alsopleasenoteifyourchildrenhaveearned
income,investmentincome,aremarried,orarenotresidingwithyouasthecustodialparent. Alsoindicateifyouhavedependents
otherthanchildrenthatareU.S.citizensorresidents. Attachextrasheetforanswersifneeded.
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1. Dateyouarrivedtolive&workinyourforeignresidencecountry: __________________________2. AreyoustillaresidentoftheForeignCountry? _____Yes _____No3. Ifnot,whatdatedidyoureturntotheU.S.totakeupresidencyand
towhichstatedidyoumove?___________________________________________________________
4. IfyouhavepreviouslyfiledForm2555/2555EZ(foreignearnedincomeexclusion)
with
your
return,
what
was
the
last
year
you
filed
this
form?
_____________________
IfyouwerepresentintheU.S.orU.S.possessionsduringthecalendaryearinquestion,pleasefillinthe
followinginformationforeachtriptotheU.S.(attachadditionalsheetifnecessary):
DateArrivedinU.S. DateDepartedU.S. IncomeEarnedinU.S.
(indicatewhichstate)
EmployersName
$ ____State
$ ____State
$ ____State
IfyoumovedtoorfromtheU.S.thisyearyoumayneedtoqualifyundera330dayphysicalpresencetest. Inthatcase,weneeda
scheduleof
all
U.S.
trips
through
todays
date
NOTE: Youcanusewww.oanda.com/currencyforhistoricalcurrencyconversions(typicallyaverage
exchangeratefortheyearisused).
PRIMARYTAXPAYEREARNEDINCOMEINFORMATION:
5. EmployersNameandAddress:__________________________________________________________6. EmployersU.S.officeaddress(ifany):___________________________________________________7. Employerisa____ForeignCompany_____U.S.Company_____ForeignSubsidiaryofaU.S. Company8. Grosswages/salaryearnedinforeigncountryforcalendaryearinUSDollars:____________________9. ForeignIncomeTaxespaidforCalendartaxyearonyoursalaryinUSDollars:_____________________10. Indicatecurrencyinwhichforeignwages/taxesarepaidandexchangerateyouused:______________11. Ifapplicable,isallincomeonaFormW2issuedbyaU.S.company?______Yes_________NoSPOUSESEARNEDINCOMEINFORMATION:
12.EmployersNameandAddress:__________________________________________________________13. EmployersU.S.officeaddress(ifany):___________________________________________________14. Employerisa____ForeignCompany_____U.S.Company_____ForeignSubsidiaryofaU.S. Company15. Grosswages/salaryearnedinforeigncountryforcalendaryearinUSDollars:____________________16. ForeignIncomeTaxespaidforCalendartaxyearonyoursalaryinUSDollars:_____________________17. Indicatecurrencyinwhichforeignwages/taxesarepaidandexchangerateyouused:______________18. Ifapplicable,isallincomeonaFormW2issuedbyaU.S.company?______Yes_________No
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NOTE: Insomecountries(U.K.,Australia,HongKong)thenormaltaxyearisafiscalyear(suchasApril6to
April5). However,allincome,deductions,andtaxcreditsmustbereportedonaCalendarYearBasis(Jan1
toDec31). Thereforeitmaybenecessarytoadjustyourforeignfiscalyearincome/taxesfromyourforeign
taxreturntothecorrectcalendaryearamountacceptablebytheIRS.
IMPORTANT: ThereisnoforeignincomeexclusionallowedforcalculatingSelfEmploymentTaxes
(FICA/Medicare)unlessyouliveinacountrythathasaSocialSecurityAgreement/TreatywiththeU.S.
(Approx20
countries)
and
you
are
paying
the
equivalent
social
security
tax
in
that
country.
If
applicable,
acertificatefromthatcountryshowingpaymentcompliancemayberequired. Ifselfemployedyouwill
owetheU.S.selfemploymentsocialsecuritytaxonyournetbusinessincome(upto15.3%)unlessyou
arecoveredbythesocialsecurityagreement/treatyinyourcountryofresidence.
19. Wereyouoryourspouseselfemployedorindependentcontractorsintheforeign
country?
_____Yes_____No
20. TypeofBusiness21. BusinessName22.
EIN
Number,
if
any
(US
ID
number)
23. Ownership _____Husband_____Wife_____JointIfselfemployedinbusiness,pleasecompleteastatementofincomeanditemizedexpensesforthebusiness
forthiscalendaryearandattachthestatementtothispacket. Youmayrequestourselfemployment
questionnairesupplement). Listtotalsbelow:
24. TotalgrossbusinessincomefortaxyearinUSD $25. TotalbusinessexpensesfortaxyearinUSD $26. Doyourentorownyourresidenceoverseas,orisitprovidedbyemployer?____Rent____Own
_____ProvidedbyEmployer
27. Ifemployerprovidedhousing,amountpaidbyemployer: $____________. Isthishousingamountalreadyincludedintheincomeyouprovidedinquestion#8? _________Yes_________No
28. RentandUtilitiespaidonforeignresidence,otherthantelephone: __________________________29. Indicatefamilymemberslivingwithyouoverseasandforwhatperiod:
__________________________________________________________________________________
30. Areyourequiredtopayincometaxesintheforeigncountry? _____Yes _____No31. WhattypeofVisadoyouholdforyourresidentcountry?___________________________________ USEMPLOYMENTEARNEDINCOME: Ifyoumovedtoaforeigncountryduringthisyearormovedbackto
theU.S.duringthistaxyearpleasecompletethisquestionrelatingtoyourperiodofU.S.employment:
32.Employer
Name
and
Address
(if
self
employed
indicate
and
attach
a
list
of
income/expense
for
the
U.S.
periodoftime):_______________________________________________________________________
33.Occupation:_________________________________________________________________________34.Income: __________________________________________________________________________35.Periodoftimeworkingforthisemployer:__________________________________________________ 36. W2attached?(provideW2breakdownifavailable)_________________________________________
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RENTALINCOMEANDEXPENSES
IfyouownrentalpropertyintheU.S.orabroad,pleaseattachasheetshowingallincomeandsummarized
expensesfortheyear. Ifwedidnotdoyourreturnlastyear,wewillalsoneedthedatetherentalbegan,
amountpaidforproperty,amountallocabletoland,anymajorimprovements,andacopyoftheprevious
depreciationscheduleifpreviouslydepreciated. (Askusforarentalpropertyquestionnaireifyouneedto
giveusthisdataanditwillbeemailedtoyou).
Indicatehowmanypropertiesyouhaverentedout
orhadavailableforrentthistaxyear,ifany.
Pleaseprovidelocationsofpropertiesanddescribe
therentalactivities.
37. DoyoumaintainaU.S.homewhilelivingabroad? Ifso,provideaddress:_____Yes _____No____________________________________________________________________________________
38. IfyourU.S.residenceisoccupiedindicatewhoislivingintheresidence,theirrelation,andwhetherthisresidenceisrented:_________________________________________
____________________________________________________________________________________
NONEARNEDINCOME (Attachseparatesheetsifadditionalspaceneededforanyitems)
InterestIncome(IndicatecurrencyifnotlistedinUSD):
Description/Payor LocationofPayor
ifnotU.S.
OrdinaryInterest TaxFreeInterest ForeignTaxesPaid
$ $ $
$ $ $
$ $ $
Dividend
Income
(Indicate
currency
if
not
listed
in
USD):
Description/Payor LocationofPayor
ifnotU.S.
OrdinaryDividend QualifiedPortion CapitalGain
Distribution
$ $ $
$ $ $
$ $ $
Iftherewereforeigntaxeswithheldfromanypleaseprovidefurtherinformation.
CapitalGainIncome(Stockorpropertysalesincludeanystatements):
Description Country Date
acquired
DateSold Salesprice Originalcostplus
purchasefees
$
$
$ $
$ $
IftherewereforeigntaxespaidonorU.S.taxeswithheldfromthesetransactionsletusknow. Alsoensure
youhaveindicatedthecurrencyaccuratelyifnotU.S.Dollars. Pleaseprovideuswiththerealizedgain/loss
reportfromyourbroker.
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OtherIncome(forinstance,directorsfees,retirement,socialsecurity,alimony,debtforgiveness,gambling
winnings,etc.):
Description/Payor Locationofother
income
Amountofincome Explanation
$
$
Pleaseindicateifyousoldyourprincipalresidence/formerprincipalresidencethisyear ____Yes___No
DEDUCTIONS
Describedeductions,theamountspaid,anddatespaid. Ifadeductiondoesnotapplytoyou,youcanleave
blankorindicateN/A.
39. MedicalandDentalExpenses(pleasenotetheseneedtoexceed7.5%ofgrossIncometoreceiveanybenefit). Youmayalsoincludemedical/dentalinsurancepremiums. US$_________________________
40. InterestonHomeMortgageinUSA(pleaseadviseifyouhavemortgagesonmorethan2homes).US$_________________________________________________________________________________
41. InterestonMortgageoutsidetheUS(statenameandaddressofentitytowhichyoupaidforeignmortgagepayments).Alsoindicatecurrency:_______________________________________________
42. Interestonanyothermortgagesuchasasecondmortgage/homeequityloan:________________Pleasedescribe:______________________________________________________________________
43. Indicateifyourefinancedamortgagethisyear: _____Yes______No44. AutoLicenseFees US$________________________ 45. SalesTaxpaidtoaU.S.stateifany(thisgenerallyonlyappliestoresidentsinanoincometaxstate):
US$________________________
46. PropertyTaxesonU.S.property(indicatewhichpropertyifmorethanone):Pleaseprovidecopyofproperty
tax
bill
ifaCalifornia
property.
US$________________________________________________
47.PropertyTaxesonForeignproperty(describeproperty):US$___________________________________ 48.U.S.CharitablecontributionstoU.S.Charities onlyforwhichyouhaveproperdocumentation(provide
detailedinformationaboutdonations):
_____________________________________________________________________________________
49.InvestmentInterestExpenses(suchasamarginloan): US$_________________________ 50.OtherInvestmentExpenses(describe): US$_________________________________________________ 51.TaxPreparationFeespaidduringthetaxyear US$_________________________ 52.ProvideDetailsofanymovingorstorageexpenses:___________________________________________ 53.InterestonStudentLoans(indicatewhofor)_______________________________________________54.TuitionandotherEducationalexpenses(providedetails):____________________________________OTHERQUESTIONS/INFORMATION
55. ForeignTaxespaidonincomeotherthanwagessuchasonforeigninterest,dividends,rents,royalties,etc.thisdoesnotincludeVAT.____________________________
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56. Rolledoverforeigntaxcreditsfrompreviousyears(ORprovideschedulefromprioryearreturn) ________________________________
57. Doyoufileanonresidentstatereturninanystate? Ifso,why?_____________________________________________________________________________________
58. Wasanyofyourincomereceivedthisyearfromstockoptions,deferredcompensationplans,orotherexecutiveplans?_______________________________________________________________________
59. Areyoucoveredbyaforeignpensionplan(notU.S.qualified)?Contributionsmaybetaxable,orrequireadditionalspecialreportingformseachyear.________________________________________________
60.Investmentsinaforeignmutualfund(nottradedontheU.S.stockmarket)canbesubjecttoaverycomplicatedandadversetaxcalculationintheU.S. Itisimportantwearenotifiedoftheseinvestments
sowecandotherequiredcalculations. Doyouhaveinvestmentsinforeignmutualfundswhicharenot
partofyourUSbrokerageaccount? ___________Yes __________No
61. Doyoumakecontributionstoanyretirementplan(otherthan401(k))orwantto? Areyouinterestedinconverting
toaROTHIRA,ifeligible? Checkallthatapplyandprovide
relevantinformation
______Imakecontributions
______Idonotmakecontributions
______Myspousecontributes
______Iaminterestedinmaking
contributions______Iaminterestedin
convertingtoaROTH
62.DoyouwanttohaveanytaxrefunddirectlydepositedintoyourU.S.checkingorsavingsaccount? Ifso,please
providethefollowingbankinginformation. Incertain
casesyourtaxbalancedue(ifany)canbeautomatically
withdrawnfromyourbankaccountwhenweefileyour
returnandonlyafteryoureturnyourauthorizationform
confirmingyouragreementoftaxdue.Ifyouare
interestedin
electronic
payment
of
tax
due
check
here
___
___________________NameofBank
___________________Routing#(9
digitnumberonbottomleftofcheck)
____________________AcctNumber
____Checking____Savings
63.Didyoumakeanyquarterlyestimatedtaxpaymentsforfederalorstate? Ifso,pleaseprovidedetails:_______________________________________________________________________________
64. PleaselistanyotheritemsofincomeorexpensethatyoufeelmightaffectyourU.S.taxes,oranyotherinformationyouwanttoprovide:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
IMPORTANT ADDITIONALFORMSWHICHMAYBEREQUIRED
A. TheIRSrequiresspecialformsbefiledbyanyU.S.Taxpayerwhoownsallorpartofaforeigncorporation,foreignLLC(orequivalent),foreignLLP,foreignpartnership,orforeigntrust(suchasa
fideicomisoinMexico). Ifyoufailtofiletheseforms,youwillbesubjecttosubstantialpenaltiesifitis
everdiscoveredthatyoushouldhavefiledthoseforms. Pleaseindicatehereifyouareanownerofa
foreigncorporationortrustandwewillsendyouanadditionalquestionnairefortheinformation
requiredtobereportedinthoseforms.
Yes_____ No_____ IfYes,pleasedescribe:_______________________________________________
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B. FOREIGNFINANCIALASSETREPORTINGREQUIREMENT: Thereisanewreportingrequirement(firstinstitutedforthe2011taxyear)forindividualswhohaveSpecifiedForeignFinancialAssetsinexcess
ofcertainlevels. SpecifiedForeignFinancialassetsincludethefollowing:
DepositorCustodialaccounts(suchasbankaccounts)ataforeignfinancialinstitution,includingcertainretirementaccounts
Anyequityordebtinterestinaforeignfinancialinstitution OtherforeigninvestmentssuchasstockissuedbynonUSpersons,anyinterestinaforeign
entity,andanyfinancialinstrumentissuedbyanonUSperson.
ForeignrealestateisNOTaspecifiedforeignfinancialassetandyoudonothavetocountit,unlessitisaMexicanpropertyinafideicomiso.
IFYOURTOTALFOREIGNFINANCIALASSETS(INCLUDINGFOREIGNBANKACCOUNTS)EXCEEDTHE
FOLLOWINGLEVELSTHISFORMISREQUIRED:
FilingSituation Valueonlast
dayofthe
taxyearisat
leastthis
amount:
Or,atanytime
duringthetax
year,thevalue
isgreaterthan:
SingleorMarriedFilingSeparatetaxpayerslivingintheU.S. $50,000 $75,000
MarriedTaxpayersfilingjointlylivingintheU.S. $100,000 $150,000
TaxpayersnotfilingjointlywhoarelivingoutsidetheU.S.andwould
qualifyfortheforeignearnedincomeexclusion
$200,000 $300,000
MarriedTaxpayersfilingjointlywhoarelivingabroadandwould
qualifyfortheforeignearnedincomeexclusion
$400,000 $600,000
Thisnewrequirementdoesnotreplacetheforeignbankaccountfilingrequirement(describedbelow).
Thisisanadditionalrequirement. Ifyouaresubjecttothisrequirementwemaycontactyoufor
additionalinformation.
There
can
be
severe
civil
and
criminal
penalties
for
non
filing
of
this
form
if
necessary. Thisformisnotrequiredfortaxyearsbefore2011.
Basedontheabove,doyouhavearequirementtofilethisform? Checkoneofthefollowing:
__________Yes _______No ______Iamnotsure,contactmetodiscuss.
Pleaseexplain:_______________________________________________________________________
Ifyouronlyspecifiedforeignfinancialassetsareforeignbankorcustodialaccountscheckhere:_______
andcompletetheforeignbankaccountsectionbelow.
C. Areyouasignatoryonaforeignbankaccount,foreigninvestmentaccount,orotherforeignaccountwhether
you
are
the
owner
or
not?
________
Yes
_________
No
D. Didyouhaveanownershipinterestinaforeignbankaccount,anddidthetotalamountinallofyourforeignbankandotherfinancialaccountseverequalorexceedtheequivalentofUS$10,000atany
pointduringthistaxyear?___Yes ____No Ifyes,pleasecompletethefollowinginformation:
NOTE: QuestionsBandCrelatetotheTreasuryformTDF90.221whichrequiresreportingofforeignbank
accounts. Thisformisfiledseparatelyfromyourtaxreturnandyoucancompleteitonyourown. This
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formmustbereceivedbytheauthoritiesnolaterthanJune30thoryoumayincurseverepenalties. No
extensionsareavailablebeyondthatduedateforthisform. Theformcanbefoundat:
http://www.irs.gov/pub/irspdf/f90221.pdf
Ifyouchoosetopreparethisformonyourowncheckhere_______andprovideusacopywhencomplete.
Ifyouwouldlikeustocompletetheformforyou,pleasefillintheinformationbelow:
NameofBankorInstitution _______________________________________________
AddressofBankincl.City,Country,Postcode _______________________________________________
AccountNumber _______________________________________________
CountryofAccountLocation _______________________________________________
HighestbalanceofaccountinUSDduringtax
year(exchangeratetobeusedisasofDec31) ______________________________________________
TypeofAccount(securities,bank,pension) _______________________________________________
Indicateifspouseiscoownerorlistname,
address,andSSNofcoownerifnotspouse _______________________________________________
Nameofownerofaccountifyouonlysignontheaccountandarenotanowner.
_______________________________________________
IfyouaresubjecttothespecifiedforeignfinancialrequirementdescribedinBabove,wealsoneedto
knowthefollowingforeachaccount:
Indicateifaccountopenedorclosedthisyear Opened________________ Closed __________________
Highestvalueduringtheyearinforeign
currency(indicatecurrency) _______________________________________________
Pleaseattachadditionalsheetswiththeaboveinformationforeachofyourforeignbankaccounts,foreign
savingsaccounts,foreignstockorfinancialaccounts(thisincludescreditcardaccountswithcreditbalances).
Foreignmortgageaccountsarenotsubjecttothisrequirement. Youmayalsorequestwesendyouourforeignaccountquestionnairewhichallowsformoreaccountstobelisted. Makesuretoincludeall
interest/dividendandotherincomefromtheseaccountsintheappropriatesectionofthequestionnaire.
PleaseattachacopyofallW2sand/orany1099sreceivedfromU.S.employersorbankingor
investmentaccounts. Also,ifwedidnotprepareyourreturnlastyear,pleasesendusacopyoflastyears
stateandfederaltaxreturnspreferablybyemailattachmentorfax,butiftoolengthythenacopybymail.
Donotsendoriginalsofanyforms!Wewillnotberesponsiblefortheirmaintenanceorreturntoyou.
HAVEQUESTIONSORNEEDFURTHERINFORMATION?
[email protected]. Ifyouemailthisformtousateitheraddresswecanreplywithafeequote
foryour
approval
and
the
return(s)
can
usually
be
prepared
quickly.
We
ask
for
half
the
fee
to
begin
the
workandthenthebalanceisdueuponcompletion. OurmainU.S.phonenumbersare(562)3423017and
(949)4814094. Secureefaxescanbesentto(562)6534183. ScheduledcallsarealsoavailableonSkype
atdondnelsonorcharlesexpatcpa.
GENERALINFORMATIONANDIMPORTANTDUEDATES
Expatriates(U.S.citizenslivingabroadonApril15)aregivenanautomaticextensiontofiletheirtaxreturn
untilJune15,however,ifanytaxesareowed,themoneyisdueonApril15ifyouwishtoavoidpossible
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penaltiesandinterest. AfurtherextensionforfilingoftaxreturnsuntilOctober15maybeobtainedbyfiling
theproperextensionformbyJune15.IfyourreturnneedstobecompletedbyApril15,werecommendyourquestionnairebesubmittedtousnolaterthanMarch18.Wecanprepareanextensionforyouatnocharge.TheTreasuryformreportingforeignbankaccountsmustbereceivedbytheauthoritiesnolaterthanJune30
oryoumayincurseverepenalties. Noextensionsareavailablebeyondthatduedateforthisform.
Ifyou
own
part
of
aforeign
corporation,
foreign
partnership,
for
foreign
LLC
(or
equivalent),
the
special
IRS
taxformsrequiredforthoseentitiesaredueonthesamedatesasyourpersonaltaxreturn,includingany
extension. Ifthereisaforeigntrust,suchasaMexicanFideicomiso,theIRStaxreturnform3520Aisdueon
March15th,andthe3520form,ifrequired,isduewiththepersonaltaxreturn. Ifyoureceiveda
gift/bequestgreaterthan$100,000fromanonU.S.Personorestate,ifyoureceivedagiftfromnonU.S.
corporationsorpartnershipsinexcessofUS$14,723,orifyougiftedmorethan$13,000toanyoneperson,
anadditionalfilingmayberequiredseparatefromyourtaxreturn.
TheInternalRevenueServicerequirestaxreturnsbefiledforeveryyear,evenifyouowenotaxesdueto
foreigntaxcreditsortheforeignearnedincomeexclusion! Theforeignearnedincomeexclusioncanonlybe
claimedifyoufileataxreturnandmeettheIRSrequirementsforphysicalpresenceorbonafideresidence.
TheIRSwillcurrentlyacceptlatefiledreturnsandstillallowtheforeignearnedincomeexemptionsubjectto
thetaxesowedwiththatreturnthoughthisissubjecttochangeinthefuture. NOTE: Ifyouare
submittingdelinquentforeignbankaccountforms,delinquentforms8938,delinquentforeigncorporation
orpartnershipforms,ordelinquentforeigntrustforms,werecommendyouhaveaconsultationaboutthe
OffshoreVoluntaryDisclosureProgram(http://www.irs.gov/uac/2012OffshoreVoluntaryDisclosure
Program)or,ifyouareeligible,theIRSStreamlinedProcedure(http://www.irs.gov/uac/Instructionsfor
NewStreamlinedFilingComplianceProceduresforNonResidentNonFilerUSTaxpayers). Ifyousubmit
thesedelinquentformsoutsidethisprogramorprocedureyoumaybesubjecttomorestringentpenalties
and/orprosecution.
Ifyouareindefault,wecanhelpprepareallprioryearfederal/statetaxreturnstobringyoucurrent. Ifyou
qualifyfor
an
Offer
in
Compromise
with
the
IRS/state,
we
may
be
able
to
assist
you
with
that
application.
Pleasevisitourwebsiteatwww.taxmeless.comandlearnmoreaboutU.S.taxationforU.S.citizensliving
outsideoftheU.S. DonNelsonalsocurrentlyhasablogwithcontinuallyupdatedinformation
www.usexpatriate.blogspot.com.
ELECTRONICFILING(EFILING)
ManyclientsprefertoreceivetheirreturnsbyemailandsubmittotheIRSviamail. TheIRSisnow
mandatingelectronicfilingforeligiblereturnsunlesstheclientwantstooptout. Ifyoudonotwanttofile
electronically,orarenotsure,pleasesignthefollowingstatement. Certainreturnscannotbeelectronically
filed.
Mytaxreturnpreparerhasinformedmethats/hemayberequiredtoelectronicallyfilemy2012yearincometaxreturnForm1040ifs/hefilesitwiththeIRSonmybehalf.Idonotwanttofilemyreturnelectronicallyandchoosetofilemyreturnonpaperforms.MypreparerwillnotfilemypaperreturnwiththeIRS.IwillfilemypaperreturnwiththeIRSmyself.IwasnotinfluencedbymyPrepareroranymemberofhis/herfirmtosignthisstatement.PrimaryTaxpayer___________________________ Spouse___________________________________
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2012(andearlieryear)ExpatriateTaxReturnEngagementAgreement
To: KauffmanNelsonLLP/CharlesKauffman,CPA/DonD.Nelson,CPA
Address: 3350E.7th
St,#605,LongBeach,CA90804 Phone: (949)4814094(Don)/(562)3423017(Charles)
Fax: (562)6534183 Email: [email protected] Web: www.taxmeless.com
Theundersignedtaxpayer(s)herebyengagetheaccountingofficesofDonD.Nelson,CPA,and/orCharlesKauffmanCPA,or
KauffmanNelsonLLPtoprepare2012&_______________________(listotheryearsiftheyareinvolved)U.S.Federalandor
statetax
returns.
If
we
are
engaging
you
to
prepare
foreign
related
delinquent
forms,
we
acknowledge
notification
regarding
thepotentialpenaltiesforlatefilingoftheseformsandacknowledgenotificationregardingtheOffshoreVoluntaryDisclosure
Program(ifapplicable).
Inconnectionwiththatpreparationweunderstandthatitismy(our)obligationtoprovidecompleteandaccurate
informationonallitemsofincomeanddeductionsforthetaxyear(s)involvedandI/(we)areresponsibleforanyomissions.
Allinformationstatedinthequestionnaireistrueandcorrectandweacceptsoleresponsibilityforanyinaccuraciesor
informationnotdisclosedtothetaxreturnpreparerinwriting.
Wehavereceiptsandotherwrittendocumentstosupportalloftheinformationprovided.Wewillretaintheserecordsfora
periodofatleasttenyearsafterthedatethereturnsarefiledintheeventofataxaudit.Preparersdonotsavecopiesofthe
documentationgiveninconnectionwiththereturnpreparation.WeunderstandthatPreparershavenoobligationtoverify
orconfirmtheinformationweprovideandthatweareresponsibleforitscompletenessandaccuracy. Weunderstandthat
ourfilewillonlyberetainedbyPreparersofficeforfiveyearsfromthedatetheserviceisrenderedandwillthenbe
destroyed.
Wealsounderstandthatthecostofpreparingourtaxreturnsisdependentonthecompletenessofthedatawesupplyto
Preparersandthecomplexityandnumberofvarioustaxforms,calculationsandschedulesthatmust,bylaw,beincludedin
ourreturns. Thecostofthepreparationofthereturn/swillincreaseabovethefeeoriginallyquotedifdatareceivedismore
complexthanoriginallyprovided/described,isincomplete,orifadditionaltimemustbespentsortingthroughsource
documentsnotsummarizedbythetaxpayer.Weagreetothisfeeincreaseinadvanceandacknowledgeitispossible.
Theestimatedfeeforpreparingthereturn(s)hasbeengiventousorallyorbyemail. Paymentofatleastonehalfofthatfee
isdueatthebeginningofthereturnpreparationandtheremainderisdueuponthecompletionofthereturns. Anyamount
notpaidwithin10daysofcompletionofthereturnswillbesubjecttoacarryingchargeof1.5%permonth. Paymentscanbe
madebycash,creditcard,U.S.check,wiretransfer,orPayPal.Weunderstandwemustpayanywiretransferfeesincurred
and2%forcreditcardprocessingfees. IfanylegalproceedingisrequiredinorderforPreparerstocollectthesumsowed,we
willbeliableforattorneyfeesandcostsofsuit. Weunderstandthatinterestandpenaltiesmayapplyfortaxesduewhichare
paidafterApril15andacknowledgethisnotification.
WeareretainingPreparerssolelyintheircapacityasCertifiedPublicAccountantstoprepareourtaxreturns. Weunderstand
thattheyareactinginnootherprofessionalcapacity. Ifwerequestanyotherservices,weagreethatwemustfirstenterinto
aseparatewrittenretaineragreementinconnectionwiththosematters. Anyrepresentationbeforetaxagenciesforaudits
orothermatterswillbesubjecttoextrafees.
WefurtherrepresentthatifweinstructedyouthatourforeignearnedincomeshouldnotbeshownonScheduleCasself
employed,thatwehaverepresentedtoPreparersthatwearebonafideemployeesofaforeignemployerandsubjectto
foreignincometaxwithholdingandasocialsecurityequivalent. Weacceptfullresponsibilityfordocumentingandproving
thisfactintheeventweareauditedbytheIRS. Weunderstandthatifweareindependentcontractors,wemustpayupto
15.3%U.S.selfemploymenttaxonourforeignearnedincomeafterdeductingallapplicablebusinessexpenses.Preparersare
notresponsibleforanypenalties,interestortaxesresultingfromourfailuretoproperlyshowusasselfemployed.
INWITNESSWHEREOF,thisagreementisexecutedonthedatesfirststatedbelow:
TaxpayerSignature:__________________________ SpouseSignature:_______________________________Typingyournameaboveisdeemedtobeasignature,forinstanceifyoudonothaveaccesstoascanner
PrintedTaxpayerName:______________________ PrintedSpouseName:___________________________
DateSigned:________________________________ DateSigned:___________________________________
{Note:Thisengagementagreementmustbesignedanddatedandreturnedtousinorderforustoprepareyourreturn(s)
withyourinitialretaineroncewehaveprovidedyouwithafeequote.