12 Expat Questionnaire Final PDF Fill in Version

7/28/2019 12 Expat Questionnaire Final PDF Fill in Version

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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.

Documents

12 Expat Questionnaire Final PDF Fill in Version