Form 2555–EZ Foreign Earned Income Exclusion 2010 Page 2

Summary: This is an example of Form 2555–EZ (2010) as pertains to the text. The line items are completed as follows:

Name shown on Form 1040 field contains Judith E. Adams
Your social security number field contains 221-00-2222
Under Part I: Tests To See If You Can Take the Foreign Earned Income Exclusion:
- 1a. Were you a bona fide resident .... field contains checkbox checked No
- 2a. Were you physically present ... field contains checkbox checked Yes
- 2b. The physical presence test is based on the 12–month period from field contains 1-1-10 through 12-31-10