Form

1040 NR-EZ

U.S. Income Tax Return for Certain

OMB No. 1545-1468

Nonresident Aliens With No Dependents

002

Department of the Treasury Internal Revenue Service

Your first name and initial

Last name

Identifying number (see page 3)

	
	
Country	
Of what country were you a citizen or national during 2002?	

Give address outside the United States to which you want any refund check mailed. If same as above, write “Same.”

Give address in the country where you are a permanent resident. If same as above, write “Same.”

Filing status (see page 4). Check only one box.

21

Single nonresident alien

Married nonresident alien

3 Wages, salaries, tips, etc. Attach Form(s) W-2 (see page 4)

	

4 Taxable refunds, credits, or offsets of state and local income taxes (see page 4)
5 Scholarship and fellowship grants. Attach explanation (see page 4)
6 Total wages and scholarships exempt by a treaty from page 2, Item J
7 Add lines 3, 4, and 5

	

6

	

8 Student loan interest deduction (see page 5)

	

9 Scholarship and fellowship grants excluded (see page 6)

	

10 Adjusted gross income. Subtract the sum of line 8 and line 9 from line 7

	

11 Itemized deductions. Enter state and local income taxes paid. Residents of India, see page 6
12 Subtract line 11 from line 10

	

13 Exemption deduction (see page 6)

	

14 Taxable income. Subtract line 13 from line 12

15 Tax. Find your tax in the Tax Table on pages 11–15

	

16 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137

17 Add lines 15 and 16. This is your total tax

	

18 Federal income tax withheld (from Form W-2 and/or Form 1042-S)
19 2002 estimated tax payments and amount applied from 2001 return 20 Credit for amount paid with Form 1040-C

	

21 Add lines 18 through 20. These are your total payments

	

Refund

22 If line 21 is more than line 17, subtract line 17 from line 21. This is the amount you overpaid

23a Amount of line 22 you want refunded to you

	

bRouting number

c Type:

Checking

Savings

d Account number

Direct

deposit? See

page 6 and fill

in 23b, 23c,

and 23d.

24 Amount of line 22 you want applied to your 2003 estimated tax

24

Amount

25 Amount you owe. Subtract line 21 from line 17. For details on how to pay, see page 7

You Owe

26 Estimated tax penalty (see page 7). Also include on line 25

26

Third

Party

Designee

Do you want to allow another person to discuss this return with the IRS (see page 7)?

Yes. Complete the following.

name

Designee’s

no.

Phone

Personal identification

No

number (PIN)

Sign

Here

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and accurately list all amounts and sources of U.S. source income I received during the tax year. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Keep a copy of

Your signature

Date

Your occupation in the United States

this return for

your records.

Paid

Preparer’s

signature

Date

Check if

self-employed

Preparer’s SSN or PTIN

Pre‑

parer’s

Firm’s name (or

Use Only

yours if self-employed),

address, and ZIP code

For Disclosure and Paperwork Reduction Act Notices, see page 9 of instructions.

Cat. No. 21534N

Form 1040NR-EZ (2002)

Present home address (number, street, and apt. no., or rural route). If a P.O. box, see page 4.

City, town or post office, state, and ZIP code. If a foreign address, see page 4.

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EIN		
Phone no.		

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Form 1040NR-EZ (2002)

Page 2

Other Information (If an item does not apply to you, enter “N/A.”)

A What country issued your passport?

B	Were you ever a U.S. citizen?

Yes

No

C Give the purpose of your visit to the United States

D	Type of entry visa

and current nonimmigrant status and date of change

E	Date you entered the United States (see page 8)

F Did you give up your permanent residence as an immigrant in the United States this year?

Yes

No

G	Dates you entered and left the United States during the year. Residents of Canada or Mexico entering and

leaving the United States at frequent intervals, give name of country only.

H	Give number of days (including vacation and nonworkdays) you were present in the United States during

2000

, 2001

, and 2002

I Did you file a U.S. income tax return for any year before 2002?

	

Yes

No

If “Yes,” give the latest year and form number

J If you are claiming the benefits of a U.S. income tax treaty with a foreign country, give the following information. See page 8 for additional information.

●	Country

●	Type and amount of income exempt from tax and the applicable tax treaty article. Enter treaty-exempt income for 2002 below and on line 6; not on line 3 or 5.

For 2002

For 2001

●	Were you subject to tax in that country on any of the income that you claim is entitled to the treaty benefits?

	

Yes

No

K	During 2002, did you apply for, or take any affirmative steps to apply for, lawful permanent resident status

in the United States or have an application pending to adjust your status to that of a lawful permanent resident of the United States?

	

Yes

No

If “Yes,” explain

Form 1040NR-EZ (2002)

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