0515 Form 9249 (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f9249.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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(May 2015)

Department of the Treasury - Internal Revenue Service

Taxpayer's name and address In reply refer to:

Tax year

Last four digits of Social Security Number

To assist us in the examination of your tax return, provide the following requested information and documentation for the tax year shown above. If not applicable, write "N/A." If you submit original documentation, it will be returned to you at the conclusion of the examination.

1. Dates you lived in a foreign country for the tax year shown above 2. Address in Foreign country for which expenses are claimed

2. Type of accommodation

a. House b. Apartment c. Mobile home d. Other (Explain)

4. Did you own or rent your house, apartment, mobile home,or other type of accommodation in the foreign country Yes No

5. Did your employer own the residence you occupied in the foreign country Yes No

6. Did your employer rent the foreign residence you occupied from another party on your behalf Yes No

If Yes, how much does your employer pay to the owner of the property $

7. Did your employer pay any part of your housing expenses, or reimburse you for them Yes No

If Yes, how much does your employer pay to the owner of the property

Amount you paid $

Amount your employer paid $

Amount your employer reimbursed you $

8. Did you (or your spouse) receive any housing allowance from the U.S. Government Yes No

If Yes, indicate amount received $

9. Did you maintain a second foreign household for your spouse and/or dependents due to adverse living conditions

at your foreign tax home

10. Itemize all housing expenses and attach proof of payment

Kind of Expense Amount $ $ $ $ $ $ $ $ $ $ $ $

Yes No

Catalog Number 12664Q www.irs.gov Form 9249 (Rev. 5-2015)

11. Did you or your spouse receive any income from an employer in the year shown at the top of this form which was earned in another year

If Yes, show Amount $ Year earned

12. Did you or your spouse receive any income from an employer in another year that was earned in the year shown at the top of this form

If Yes, show Amount $ Year earned

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Yes No

Yes No

13. Did you move during the year shown at the top of this form, or the year before Yes No

If Yes, provide the following information:

a. Date you moved to new location

b. Amount of your moving expense deduction $

c. Amount you were reimbursed for move by your employer $

(Include amounts your employer paid directly to shippers, airlines, hotels, or anyone else on your behalf)

d. If your move was not during the year shown at the top of this form, attach a copy of Form 2555, Foreign Earned Income, for the

year you moved.

14. If you were self-employed, did you have any carryover housing costs from the preceding tax year Yes No

If Yes, provide a complete copy of the preceding year's tax return and verification for the housing expenses

Remarks

Certification: Under penalty of perjury, I declare that I have examined this statement and, to the best of my knowledge and belief, it is true, correct, and complete

Taxpayer's signature SIGN Date

Catalog Number 12664Q www.irs.gov Form 9249 (Rev. 5-2015)