Form 1040-NR - U.S. Nonresident Alien Income Tax Return Form (2014)

Form 1040NR
Department of the Treasury
Internal Revenue Service
U.S. Nonresident Alien Income Tax Return
Information about Form 1040NR and its separate instructions is at www.irs.gov/form1040nr.
For the year January 1–December 31, 2014, or other tax year
beginning , 2014, and ending , 20
OMB No. 1545-0074
2014
Please print
or type
Your first name and initial Last name Identifying number (see instructions)
Present home address (number, street, and apt. no., or rural route). If you have a P.O. box, see instructions.
Check if:
Individual
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 Foreign province/state/county Foreign postal code
Filing
Status
Check only
one box.
1
Single resident of Canada or Mexico or single U.S. national
2
Other single nonresident alien
3
Married resident of Canada or Mexico or married U.S. national
4
Married resident of South Korea
5
Other married nonresident alien
6
Qualifying widow(er) with dependent child (see instructions)
If you checked box 3 or 4 above, enter the information below.
(i) Spouse’s first name and initial (ii) Spouse’s last name (iii) Spouse’s identifying number
Exemptions
If more
than four
dependents,
see instructions.
7 a
Yourself. If someone can claim you as a dependent, do not check box 7a . . . .
b
Spouse. Check box 7b only if you checked box 3 or 4 above and your spouse did not
have any U.S. gross income . . . . . . . . . . . . . . . . . . .
}
Boxes checked
on 7a and 7b
c
Dependents: (see instructions)
(1) First name Last name
(2) Dependent’s
identifying number
(3) Dependent’s
relationship to you
(4) if qualifying
child for child tax
credit (see instr.)
No. of children
on 7c who:
• lived with you
• did not live with
you due to divorce
or separation (see
instructions)
Dependents on 7c
not entered above
d Total number of exemptions claimed . . . . . . . . . . . . . . . . .
Add numbers on
lines above
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.
8 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . 8
9a Taxable interest . . . . . . . . . . . . . . . . . . . . . . . . 9a
b Tax-exempt interest. Do not include on line 9a . . . . . 9b
10a Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . 10a
b Qualified dividends (see instructions) . . . . . . . . 10b
11 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) . . 11
12
Scholarship and fellowship grants. Attach Form(s) 1042-S or required statement (see instructions)
12
13 Business income or (loss). Attach Schedule C or C-EZ (Form 1040) . . . . . . . . 13
14
Capital gain or (loss). Attach Schedule D (Form 1040) if required. If not required, check here
14
15 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . . . 15
16a IRA distributions . . 16a 16b
Taxable amount (see instructions)
16b
17a Pensions and annuities 17a 17b
Taxable amount (see instructions)
17b
18 Rental real estate, royalties, partnerships, trusts, etc. Attach Schedule E (Form 1040) . . 18
19 Farm income or (loss). Attach Schedule F (Form 1040) . . . . . . . . . . . . 19
20 Unemployment compensation . . . . . . . . . . . . . . . . . . . 20
21 Other income. List type and amount (see instructions) 21
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 . . . . . . . . . . . . . . . . . .
23
Adjusted
Gross
Income
24 Educator expenses (see instructions) . . . . . . . . 24
25 Health savings account deduction. Attach Form 8889 . . . 25
26 Moving expenses. Attach Form 3903 . . . . . . . . 26
27
Deductible part of self-employment tax. Attach Schedule SE (Form 1040)
27
28 Self-employed SEP, SIMPLE, and qualified plans . . . . 28
29 Self-employed health insurance deduction (see instructions) 29
30 Penalty on early withdrawal of savings . . . . . . . . 30
31 Scholarship and fellowship grants excluded . . . . . . 31
32 IRA deduction (see instructions) . . . . . . . . . . 32
33 Student loan interest deduction (see instructions) . . . . 33
34 Domestic production activities deduction. Attach Form 8903 . 34
35 Add lines 24 through 34 . . . . . . . . . . . . . . . . . . . . . 35
36 Subtract line 35 from line 23. This is your adjusted gross income . . . . . . .
36
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Cat. No. 11364D
Form 1040NR (2014)
Page 1/5
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Form 1040-NR - U.S. Nonresident Alien Income Tax Return Form (2014) PDF

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