IRS FORM 8833 [TREATY BASED RETURN POSITION DISCLOSURE]

Form 8833 (Rev. September 2017) Treaty-Based Return Position Disclosure Under Section 6114 or 7701(b) OMB No. 1545-1354 Department of the Treasury ▶Attach to your tax return. ▶ Go to www.irs.gov/Form8833 for the latest information. Internal Revenue Service... More

Form 8833 (Rev. September 2017) Treaty-Based Return Position Disclosure Under Section 6114 or 7701(b) OMB No. 1545-1354 Department of the Treasury ▶Attach to your tax return. ▶ Go to www.irs.gov/Form8833 for the latest information. Internal Revenue Service Attach a separate Form 8833 for each treaty-based return position taken. Failure to disclose a treaty-based return position may result in a penalty of $1,000 ($10,000 in the case of a C corporation) (see section 6712). Name U.S. taxpayer identifying number Reference ID number, if any (see instructions) Address in country of residence Address in the United States Check one or both of the following boxes as applicable. • The taxpayer is disclosing a treaty-based return position as required by section 6114 . . . . . . . . . . . . . ▶ • The taxpayer is a dual-resident taxpayer and is disclosing a treaty-based return position as required by Regulations section 301.7701(b)-7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ Not Less