Form 2555 Foreign Earned Income 2009

Summary: This is an example of Form 2555 (2009) as pertains to the text. The line items are completed as follows:

Name shown on Form 1040 field contains James M. Adams
Your social security number field contains 111-00-1111
Under Part I: General Information:
- 1. Your foreign address (including country) field contains 10 North Avenue, City A, Country X
- 2. Your occupation field contains Engineer
- 3. Employer's name field contains Pan American Oil Company
- 4a. Employer's United States address field contains Not Applicable
- 4b. Employer's foreign address field contains 65 South Avenue, City A, Country X
- 5. Employer is (check any that apply): a. A foreign entity checkbox checked
- 6a. If, after 1981, you filed Form 2555 to claim either of the exclusions or Form 2555-EZ to claim the foreign earned income exclusion, enter the year you filed the form. field contains 2005
- 6c. Have you ever revoked either of the exclusions? No checkbox checked
- 7. Of what country are you a citizen/national? field contains United States
- 8a. Did you maintain a separate foreign residence for your family because of adverse living conditions at your tax home? See Second foreign household on page 3 of the instructions. Yes checkbox checked
- 8b. If Yes, enter city and country of the separate foreign residence. Also, enter the number of days during your tax year that you maintained a second household at that address. field contains City Y, Country Y 365 days
- 9. List your tax home(s) during your tax year and date(s) established. field contains City A, Country X 6-9-06