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For which year(s) do you need to file? For other years, please specify in additional information.

Name

First

Last

Email

Address

City

Country

Occupation

Date of Birth

Month / Day / Year

On December 31, 2022, you were

Since when are you living outside of the US?

Month / Day / Year

In which US state did you last live?

Did you have income of more than the equivalent of USD 112,000 during 2022? For other years, please specify in additional information.

Did you earn income in the US during 2022?

If yes, what kind of income? (income from rental property, sales, dividends, royalties, etc.)

Did you receive a W2 or a certificate of income from your employer?

Did you earn any other income other than your salary in a foreign country?

If yes, what kind of income? (income from rental property, sales, dividends, royalties, etc.)

Do you pay taxes in the foreign country where you are living?

Was the total value of all of your foreign bank accounts more than the equivalent of USD 10,000 during 2022?

Any additional information?