0124 Form 1040-C (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f1040c.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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(Rev. January 2024)

Department of the Treasury Internal Revenue Service

For tax period or year beginning, 20, and ending, 20

Go to www.irs.gov/Form1040C for instructions and the latest information.

File original and one copy.

OMB No. 1545-0074

Print or Type

Your first name and initial Last name Your social security number

If a joint return, spouse’s first name and initial (see instructions) Last name Spouse’s identifying number

U.S. address (number, street, and apt. no. or rural route)

City, state, and ZIP code

Passport or alien registration card number

Your number Spouse’s number

Date on which you first arrived in the U.S.

Date of departure

Complete foreign address Date on which you last arrived in the U.S.

Of what country are you a citizen or national? Of what country are you a resident for tax purposes?

Caution: Form 1040-C is not a final income tax return. You must file a final return on the correct form after your tax year ends. See Final Return Required in the instructions.

Part I Explanation of Status—Resident or Nonresident Alien— See instructions.

1

Check the box or boxes that apply. Note: A nonresident alien who has income from U.S. real property may elect to treat this income as effectively connected income. Gain or loss on the disposition of a U.S. real property interest by a nonresident alien is effectively connected income or loss. For details, see the Form 1040-NR instructions or Pub. 519, U.S. Tax Guide for Aliens.

Group I—Resident alien. Group II—Nonresident alien with income effectively connected with a U.S. trade or business. Group III—Nonresident alien with income not effectively connected with a U.S. trade or business. 2 Type of trade or business or occupation in the United States: 3 Visa number and class under which you were last admitted to the United States:

If “Yes,” enter the expiration date: 5 Have you signed a waiver of rights, privileges, exemptions, and immunities as described under Exceptions in the instructions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No If “Yes,” enter the date signed: 6 During your stay in the United States, did you furnish Form W-9, Request for Taxpayer Identification Number and Certification, to a withholding agent? . . . . . . . . . . . . . . . . . . . Yes No 7 a Have you applied for U.S. citizenship? . . . . . . . . . . . . . . . . . . . . . . . Yes No b Have you applied for, or taken other affirmative steps to apply for, lawful permanent resident status (green

card holder) in the United States, or do you have an application pending to change your status to that of a lawful permanent resident of the United States? . . . . . . . . . . . . . . . . . . . . Yes No 8 If you filed income tax returns in the United States, give the following information for the prior tax year. a Type of return filed (for example, Form 1040, 1040-SR, 1040-NR, etc.): b Your U.S. address, if any, shown on return: c Taxable income reported $ d Total tax payments $ e Balance due $

10 Do you plan to return to the United States? . . . . . . . . . . . . . . . . . . . . . . Yes No If “Yes,” complete lines 11 through 14 below . 11 Are your spouse and any children remaining in the United States? . . . . . . . . . . . . . . Yes No 12 Show the approximate value and location in the United States of any property held by you.

Value Location

b Stocks and bonds . . . . . . . . $ ; c Cash . . . . . . . . . . . . $ ; d Other (specify): $ ;

13

13 At any time during the tax year, did you: (a) receive (as a reward, award, or payment for property or

services); or (b) sell, exchange, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 14 If you will not return to the United States before the due date for filing a final U.S. income tax return for the current year or the

If you will not return to the United States before the due date for filing a final U.S. income tax return for the current year or the due date for filing a final U.S. income tax return for the preceding year, what arrangements have you made to file the final income tax return(s) and pay the tax(es)?

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see the instructions. Cat. No. 11310F Form 1040-C (Rev. 1-2024)

Form 1040-C (Rev. 1-2024) Page 2

Sign 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 complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

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 complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Certificate of Compliance

This certifies that the above individual(s) has satisfied all the requirements of the Internal Revenue Code and the Internal Revenue Regulations relating to departing aliens according to all information available to me at this date. This certificate is effective for the tax period

beginning, 20 , and ending, 20, or the tax year ended, 20 .

(Field Assistance Area Director)

Internal Revenue Service

Date, By

(Name) (Title)

Form 1040-C (Rev. 1-2024)

Form 1040-C (Rev. 1-2024) Page 3 Schedule A Income— See instructions.

Connected With a U.S. Trade or Business— See instructions. Include any U.S. income tax that was paid or withheld on these sales or exchanges on Schedule A, line 3, column (c).

• If you are a resident alien reporting income on Schedule A, column (d), you may claim the same deductions allowable on Schedule A (Form1040).

• If you are a nonresident alien reporting income on Schedule A, column (e), you may claim only deductions that are connected to U.S. trade or business income and not deducted elsewhere. See Schedule A (Form 1040-NR). However, casualty or theft losses and charitable contributions do not have to be related to U.S. trade or business income. You should file Form 4684, Casualties and Thefts, to support casualty or theft losses shown below. See instructions for the extent to which casualty and theft losses are deductible.

• If you are a nonresident alien reporting income on Schedule A, column (f), do not claim any deductions related to that income.

Form 1040-C (Rev. 1-2024)

Form 1040-C (Rev. 1-2024) Page 4 Schedule D Tax Computation— See instructions.

Tax for Resident Alien—Group I Only (For description of groups, see line 1 on page 1.)

1 Enter amount from page 2, line 18 . . . . . . . . . . . . . . . . . . . . . . . 1

2 If you itemize deductions, enter amount from page 3, Schedule C, line 2. If you do not plan to itemize deductions, enter your standard deduction. See Standard Deduction (Group I only) in the instructions 2

3 Taxable income. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . 3

4

Tax. Figure your tax on the amount on line 3 by using the current year’s Tax Rate Schedules in the instructions. Include in the total any tax from Form 4972 and Form 8814. Enter the tax here . . . . 4

5 Alternative minimum tax (AMT). Enter the amount, if any, of AMT from Form 6251 . . . . . . 5

6 Add lines 4 and 5. Enter the result here and on Form 1040-C, line 19 . . . . . . . . . . . 6

Tax for Nonresident Alien With Income Effectively Connected With a U.S. Trade or Business—Group II Only

7 Enter amount from page 2, line 18 . . . . . . . . . . . . . . . . . . . . . . . 7

8 Enter itemized deductions from page 3, Schedule C, line 2 . . . . . . . . . . . . . . 8

9 Taxable income. Subtract line 8 from line 7 . . . . . . . . . . . . . . . . . . . 9

10 Tax. Figure your tax on the amount on line 9 by using the current year’s Tax Rate Schedules in the instructions. Include in the total any tax from Form 4972 and Form 8814. Enter the tax here . . . . 10

11 Alternative minimum tax (AMT). Enter the amount, if any, of AMT from Form 6251 . . . . . . 11

12 Add lines 10 and 11. Enter the result here and on Form 1040-C, line 19 . . . . . . . . . . 12

Form 1040-C (Rev. 1-2024)