Form 2555-EZ Foreign Earned Income Exclusion 2011

Summary: This is an example of Form 2555-EZ (2010) with items included as described in the text. Additionally, the following line items are completed:

Name shown on Form 1040 field contains Judith E. Adams
Your social security number field contains 222-00-2222
Under Part I: Tests To See If You Can Take the Foreign Earned Income Exclusion:
- 1. Bona Fide Residence Test
- a. Were you a bona fide resident of a foreign country or countries for a period that includes an entire tax year (see page 2 of the instructions) ? No checkbox checked
- 2. Physical Presence Test
- a. Were you physically present in a foreign country or countries for at least 330 full days during 2010 or any other period of 12 months in a row starting or ending in 2010? Yes checkbox checked
- b. The physical presence test is based on the 12-month period from field contains 1-1-10 through 12-31-09
- 3. Tax Home Test. Was your tax home in a foreign country or countries throughout your period of bona fide residence or physical presence, whichever applies? Yes checkbox checked
Under Part II: General Information:
- 4. Your foreign address (including country) field contains
- - 21 Rue Reynaud
  - Country Y
- 5. Your occupation field contains Secretary
- 6. Employer's name field contains A B Insurance Company, Incorporated
- 7. Employer's United States address (including ZIP code) field contains
- - 2645 Pewter Place
  - Anytown, Anystate, United States of America
- 8. Employer's foreign address field contains
- - 40 Rue Royale
  - Country Y
- 9. Employer is (check any that apply): a. A United States business checkbox checked
- 10a. If you filed Form 2555 or 2555-EZ after 1981, enter the last year you filed the form. field contains 2009
- 10c. Have you ever revoked the foreign earned income exclusion? No checkbox checked
- 11a. List your tax home(s) during 2006 and date(s) established. field contains Country Y 6-1-07
- 11b. Of what country are you a citizen/national? field contains United States
Under Part IV: Figure Your Foreign Earned Income Exclusion:
- 14. Enter the number of days in your qualifying period that fall within 2010 field contains 365 days
- 15. Did you enter 365 on line 14? Yes checkbox checked Enter 1.000 field contains 1.000
- 16. Multiply line 13 by line 15 field contains 91,400
- 17. Enter in U.S. dollar, the total foreign income you earned and received in 2010 (see instructions field contains 47,000
- 18. Foreign earned income exclusion field contains 47,000

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