Form 673 Statement For Claiming Benefits Provided by Section 911 of the Internal Revenue Code (Revision March 1997)

Summary: This is an example of Form 673 (Revision March 1997). The text states:
The following statement, when completed and furnished by a citizen of the United States to his or her employer, permits the employer to exclude from income tax withholding all or a part of the wages paid for services performed outside the United States.
I understand that this total, plus the total reported on any other statements outstanding with other employers, should not be more than my expected housing cost amount exclusion.
If I become disqualified for the exclusions, I will immediately notify my employer and advise what part, if any, of the period I am qualified for.
I understand that any exemption from income tax withholding permitted by reason of furnishing this statement is not a determination by the Internal Revenue that any amount paid to me for any services performed during the tax year is excludable from gross income under the provisions of Code section 911(a).

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