EXPATRIATETAXQUESTIONNAIREFORU.S.

CITIZENSLIVINGABROAD
DonD.Nelson,CPA,Attorney/CharlesKauffman,CPA/KauffmanNelsonLLP
ThisquestionnairecanbefilledoutbyhandorinAdobeReader8.0orhigher
Indicateyearthisformiscompletedforifnot2012:__________________________________________

PrimaryTaxpayer

Spouse(writeN/Aifnotmarried)

Name

______________________________________________________

SocialSecurityNumber

______________________________________________________

DateofBirth

______________________________________________________

Profession

______________________________________________________

CitizenshipCountry

______________________________________________________

U.S.GreenCardHolder?

______________________________________________________

IndicateifGreenCardobtainedorrelinquishedthisyearanddate

DidyoufileajointU.S.returnwithyourspouselastyear?
_____Yes_____No_____N/A
Didyourmaritalstatuschangethisyear?
_____Yes_____No_____N/A
IndicateanyU.S.Stateswhereyoufiledataxreturnlastyear:
__________________________
MightyouberequiredtofileataxreturnwithaUSstateaswell?____Yes____No_____Dontknow
PleaseExplain._______________________________________________________________
ContactInformation
EmailAddress(es)
_________________________________________________________
PhoneNumbers(indicatehome,
office,ormobile)
_________________________________________________________
ResidenceAddressinForeignCountry______________________________________________________
MailingAddresstobeshownon
TaxReturn
_________________________________________________________

IfaU.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

_____No

3. Ifnot,whatdatedidyoureturntotheU.S.totakeupresidencyand
towhichstatedidyoumove?___________________________________________________________
4. IfyouhavepreviouslyfiledForm2555/2555EZ(foreignearnedincome
exclusion)withyourreturn,whatwasthelastyearyoufiledthisform?
_____________________

IfyouwerepresentintheU.S.orU.S.possessionsduringthecalendaryearinquestion,pleasefillinthe
followinginformationforeachtriptotheU.S.(attachadditionalsheetifnecessary):
DateArrivedinU.S.
DateDepartedU.S.
IncomeEarnedinU.S.
EmployersName
(indicatewhichstate)

$____State

$____State

$____State

IfyoumovedtoorfromtheU.S.thisyearyoumayneedtoqualifyundera330dayphysicalpresencetest.Inthatcase,weneeda
scheduleofallU.S.tripsthroughtodaysdate

NOTE:Youcanusewww.oanda.com/currencyforhistoricalcurrencyconversions(typicallyaverage
exchangeratefortheyearisused).

PRIMARYTAXPAYEREARNEDINCOMEINFORMATION:
5. EmployersNameandAddress:__________________________________________________________
6. EmployersU.S.officeaddress(ifany):___________________________________________________
7. Employerisa____ForeignCompany_____U.S.Company_____ForeignSubsidiaryofaU.S.Company
8. Grosswages/salaryearnedinforeigncountryforcalendaryearinUSDollars:____________________
9. ForeignIncomeTaxespaidforCalendartaxyearonyoursalaryinUSDollars:_____________________
10. Indicatecurrencyinwhichforeignwages/taxesarepaidandexchangerateyouused:______________
11. Ifapplicable,isallincomeonaFormW2issuedbyaU.S.company?______Yes_________No
SPOUSESEARNEDINCOMEINFORMATION:
12. EmployersNameandAddress:__________________________________________________________
13. EmployersU.S.officeaddress(ifany):___________________________________________________
14. Employerisa____ForeignCompany_____U.S.Company_____ForeignSubsidiaryofaU.S.Company
15. 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.
(Approx20countries)andyouarepayingtheequivalentsocialsecuritytaxinthatcountry.Ifapplicable,a
certificatefromthatcountryshowingpaymentcompliancemayberequired.Ifselfemployedyouwill
owetheU.S.selfemploymentsocialsecuritytaxonyournetbusinessincome(upto15.3%)unlessyou
arecoveredbythesocialsecurityagreement/treatyinyourcountryofresidence.

19. Wereyouoryourspouseselfemployedor
independentcontractorsintheforeign
country?
20. TypeofBusiness

_____Yes_____No

21. BusinessName

22. EINNumber,ifany(USIDnumber)
23. Ownership

_____Husband_____Wife_____Joint

Ifselfemployedinbusiness,pleasecompleteastatementofincomeanditemizedexpensesforthebusiness
forthiscalendaryearandattachthestatementtothispacket.Youmayrequestourselfemployment
questionnairesupplement).Listtotalsbelow:
24. TotalgrossbusinessincomefortaxyearinUSD

25. TotalbusinessexpensesfortaxyearinUSD

26. Doyourentorownyourresidenceoverseas,orisitprovidedbyemployer?____Rent____Own

_____ProvidedbyEmployer
27. Ifemployerprovidedhousing,amountpaidbyemployer:$____________.Isthishousingamount
alreadyincludedintheincomeyouprovidedinquestion#8?_________Yes_________No
28. RentandUtilitiespaidonforeignresidence,otherthantelephone: __________________________
29. Indicatefamilymemberslivingwithyouoverseasandforwhatperiod:
__________________________________________________________________________________
30. Areyourequiredtopayincometaxesintheforeigncountry?
_____Yes
_____No
31. WhattypeofVisadoyouholdforyourresidentcountry?___________________________________
USEMPLOYMENTEARNEDINCOME:Ifyoumovedtoaforeigncountryduringthisyearormovedbackto
theU.S.duringthistaxyearpleasecompletethisquestionrelatingtoyourperiodofU.S.employment:
32. EmployerNameandAddress(ifselfemployedindicateandattachalistofincome/expensefortheU.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 OrdinaryInterest
ifnotU.S.

TaxFreeInterest

ForeignTaxesPaid

QualifiedPortion
$

CapitalGain
Distribution
$

DividendIncome(IndicatecurrencyifnotlistedinUSD):
Description/Payor LocationofPayor OrdinaryDividend
ifnotU.S.

Iftherewereforeigntaxeswithheldfromanypleaseprovidefurtherinformation.
CapitalGainIncome(Stockorpropertysalesincludeanystatements):
Description
Country
Date
DateSold
Salesprice
acquired

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
Amountofincome Explanation
income

Pleaseindicateifyousoldyourprincipalresidence/formerprincipalresidencethisyear____Yes___No
DEDUCTIONS
Describedeductions,theamountspaid,anddatespaid.Ifadeductiondoesnotapplytoyou,youcanleave
blankorindicateN/A.
39. MedicalandDentalExpenses(pleasenotetheseneedtoexceed7.5%ofgrossIncometoreceiveany
benefit).Youmayalsoincludemedical/dentalinsurancepremiums.US$_________________________
40. InterestonHomeMortgageinUSA(pleaseadviseifyouhavemortgagesonmorethan2homes).
US$_________________________________________________________________________________
41. InterestonMortgageoutsidetheUS(statenameandaddressofentitytowhichyoupaidforeign
mortgagepayments).Alsoindicatecurrency:_______________________________________________
42. Interestonanyothermortgagesuchasasecondmortgage/homeequityloan:________________
Pleasedescribe:______________________________________________________________________
43. Indicateifyourefinancedamortgagethisyear:_____Yes______No
44. AutoLicenseFees

US$________________________

45. SalesTaxpaidtoaU.S.stateifany(thisgenerallyonlyappliestoresidentsinanoincometaxstate):

US$________________________
46. PropertyTaxesonU.S.property(indicatewhichpropertyifmorethanone):Pleaseprovidecopyof
propertytaxbillifaCaliforniaproperty.US$________________________________________________
47. PropertyTaxesonForeignproperty(describeproperty):US$___________________________________
48. U.S.CharitablecontributionstoU.S.Charitiesonlyforwhichyouhaveproperdocumentation(provide
detailedinformationaboutdonations):
_____________________________________________________________________________________
49. InvestmentInterestExpenses(suchasamarginloan):

US$_________________________

50. OtherInvestmentExpenses(describe):US$_________________________________________________
51. TaxPreparationFeespaidduringthetaxyear

US$_________________________

52. ProvideDetailsofanymovingorstorageexpenses:___________________________________________
53. InterestonStudentLoans(indicatewhofor)_______________________________________________
54. TuitionandotherEducationalexpenses(providedetails):____________________________________

OTHERQUESTIONS/INFORMATION

55. ForeignTaxespaidonincomeotherthanwagessuchasonforeign
interest,dividends,rents,royalties,etc.thisdoesnotincludeVAT.____________________________
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56. Rolledoverforeigntaxcreditsfrompreviousyears(ORprovide
schedulefromprioryearreturn)

________________________________
57. Doyoufileanonresidentstatereturninanystate?Ifso,why?

_____________________________________________________________________________________
58. Wasanyofyourincomereceivedthisyearfromstockoptions,deferredcompensationplans,orother
executiveplans?_______________________________________________________________________
59. Areyoucoveredbyaforeignpensionplan(notU.S.qualified)?Contributionsmaybetaxable,orrequire
additionalspecialreportingformseachyear.________________________________________________

60. Investmentsinaforeignmutualfund(nottradedontheU.S.stockmarket)canbesubjecttoavery
complicatedandadversetaxcalculationintheU.S.Itisimportantwearenotifiedoftheseinvestments
sowecandotherequiredcalculations.Doyouhaveinvestmentsinforeignmutualfundswhicharenot
partofyourUSbrokerageaccount?___________Yes__________No

61. Doyoumakecontributionstoanyretirementplan(other ______Imakecontributions

than401(k))orwantto?Areyouinterestedinconverting ______Idonotmakecontributions
toaROTHIRA,ifeligible?Checkallthatapplyandprovide ______Myspousecontributes
relevantinformation
______Iaminterestedinmaking
contributions
______Iaminterestedin
convertingtoaROTH

62. Doyouwanttohaveanytaxrefunddirectlydepositedinto ___________________NameofBank

yourU.S.checkingorsavingsaccount?Ifso,please
___________________Routing#(9
digitnumberonbottomleftofcheck)
providethefollowingbankinginformation.Incertain
____________________AcctNumber
casesyourtaxbalancedue(ifany)canbeautomatically
____Checking____Savings
withdrawnfromyourbankaccountwhenweefileyour
returnandonlyafteryoureturnyourauthorizationform
confirmingyouragreementoftaxdue.Ifyouare
interestedinelectronicpaymentoftaxduecheckhere___

63. Didyoumakeanyquarterlyestimatedtaxpaymentsforfederalorstate?Ifso,pleaseprovide
details:_______________________________________________________________________________
64. PleaselistanyotheritemsofincomeorexpensethatyoufeelmightaffectyourU.S.taxes,oranyother
informationyouwanttoprovide:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
IMPORTANTADDITIONALFORMSWHICHMAYBEREQUIRED
A. TheIRSrequiresspecialformsbefiledbyanyU.S.Taxpayerwhoownsallorpartofaforeign
corporation,foreignLLC(orequivalent),foreignLLP,foreignpartnership,orforeigntrust(suchasa
fideicomisoinMexico).Ifyoufailtofiletheseforms,youwillbesubjecttosubstantialpenaltiesifitis
everdiscoveredthatyoushouldhavefiledthoseforms.Pleaseindicatehereifyouareanownerofa
foreigncorporationortrustandwewillsendyouanadditionalquestionnairefortheinformation
requiredtobereportedinthoseforms.

Yes_____No_____IfYes,pleasedescribe:_______________________________________________
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B. FOREIGNFINANCIALASSETREPORTINGREQUIREMENT:Thereisanewreportingrequirement(first
institutedforthe2011taxyear)forindividualswhohaveSpecifiedForeignFinancialAssetsinexcess
ofcertainlevels.SpecifiedForeignFinancialassetsincludethefollowing:
DepositorCustodialaccounts(suchasbankaccounts)ataforeignfinancialinstitution,including
certainretirementaccounts
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.
MarriedTaxpayersfilingjointlylivingintheU.S.
TaxpayersnotfilingjointlywhoarelivingoutsidetheU.S.andwould
qualifyfortheforeignearnedincomeexclusion
MarriedTaxpayersfilingjointlywhoarelivingabroadandwould
qualifyfortheforeignearnedincomeexclusion

$50,000
$100,000
$200,000

$75,000
$150,000
$300,000

$400,000

$600,000

Thisnewrequirementdoesnotreplacetheforeignbankaccountfilingrequirement(describedbelow).
Thisisanadditionalrequirement.Ifyouaresubjecttothisrequirementwemaycontactyoufor
additionalinformation.Therecanbeseverecivilandcriminalpenaltiesfornonfilingofthisformif
necessary.Thisformisnotrequiredfortaxyearsbefore2011.
Basedontheabove,doyouhavearequirementtofilethisform?Checkoneofthefollowing:
__________Yes_______No______Iamnotsure,contactmetodiscuss.
Pleaseexplain:_______________________________________________________________________
Ifyouronlyspecifiedforeignfinancialassetsareforeignbankorcustodialaccountscheckhere:_______
andcompletetheforeignbankaccountsectionbelow.
C. Areyouasignatoryonaforeignbankaccount,foreigninvestmentaccount,orotherforeignaccount
whetheryouaretheownerornot?________Yes_________No

D. Didyouhaveanownershipinterestinaforeignbankaccount,anddidthetotalamountinallofyour
foreignbankandotherfinancialaccountseverequalorexceedtheequivalentofUS$10,000atany
pointduringthistaxyear?___Yes____NoIfyes,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
_______________________________________________

_______________________________________________
Nameofownerofaccountifyouonlysignon
theaccountandarenotanowner.

IfyouaresubjecttothespecifiedforeignfinancialrequirementdescribedinBabove,wealsoneedto
knowthefollowingforeachaccount:

Indicateifaccountopenedorclosedthisyear
Opened________________Closed__________________
Highestvalueduringtheyearinforeign

currency(indicatecurrency)
_______________________________________________
Pleaseattachadditionalsheetswiththeaboveinformationforeachofyourforeignbankaccounts,foreign
savingsaccounts,foreignstockorfinancialaccounts(thisincludescreditcardaccountswithcreditbalances).
Foreignmortgageaccountsarenotsubjecttothisrequirement.Youmayalsorequestwesendyouour
foreignaccountquestionnairewhichallowsformoreaccountstobelisted.Makesuretoincludeall
interest/dividendandotherincomefromtheseaccountsintheappropriatesectionofthequestionnaire.

PleaseattachacopyofallW2sand/orany1099sreceivedfromU.S.employersorbankingor
investmentaccounts.Also,ifwedidnotprepareyourreturnlastyear,pleasesendusacopyoflastyears
stateandfederaltaxreturnspreferablybyemailattachmentorfax,butiftoolengthythenacopybymail.
Donotsendoriginalsofanyforms!Wewillnotberesponsiblefortheirmaintenanceorreturntoyou.

HAVEQUESTIONSORNEEDFURTHERINFORMATION?
Emailusatkncpas@gmail.com.Ifyouemailthisformtousateitheraddresswecanreplywithafeequote
foryourapprovalandthereturn(s)canusuallybepreparedquickly.Weaskforhalfthefeetobeginthe
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,werecommendyour
questionnairebesubmittedtousnolaterthanMarch18.Wecanprepareanextensionforyouatnocharge.

TheTreasuryformreportingforeignbankaccountsmustbereceivedbytheauthoritiesnolaterthanJune30
oryoumayincurseverepenalties.Noextensionsareavailablebeyondthatduedateforthisform.

Ifyouownpartofaforeigncorporation,foreignpartnership,forforeignLLC(orequivalent),thespecialIRS
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
qualifyforanOfferinCompromisewiththeIRS/state,wemaybeabletoassistyouwiththatapplication.

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/hemayberequiredtoelectronicallyfilemy2012yearincome
taxreturnForm1040ifs/hefilesitwiththeIRSonmybehalf.Idonotwanttofilemyreturnelectronically
andchoosetofilemyreturnonpaperforms.MypreparerwillnotfilemypaperreturnwiththeIRS.Iwillfile
mypaperreturnwiththeIRSmyself.IwasnotinfluencedbymyPrepareroranymemberofhis/herfirmto
signthisstatement.
PrimaryTaxpayer___________________________Spouse___________________________________
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2012(andearlieryear)ExpatriateTaxReturnEngagementAgreement
To:KauffmanNelsonLLP/CharlesKauffman,CPA/DonD.Nelson,CPA
Address:3350E.7thSt,#605,LongBeach,CA90804Phone:(949)4814094(Don)/(562)3423017(Charles)
Fax: (562)6534183
Email:kncpas@gmail.com
Web:www.taxmeless.com

Theundersignedtaxpayer(s)herebyengagetheaccountingofficesofDonD.Nelson,CPA,and/orCharlesKauffmanCPA,or
KauffmanNelsonLLPtoprepare2012&_______________________(listotheryearsiftheyareinvolved)U.S.Federalandor
statetaxreturns.Ifweareengagingyoutoprepareforeignrelateddelinquentforms,weacknowledgenotificationregarding
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.

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