Summary: This is an example of Form 2555-EZ (2006) with items included as described in the text. Additionally, the following line items are completed:
Name shown on Form 1040field contains Judith E. Adams
Your social security numberfield contains 222-00-2222
Part I: Tests To See If You Can Take the Foreign Earned Income Exclusion:
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) ? Nocheckbox checked
a. Were you physically present in a foreign country or countries for at least 330 full days during 2006 or any other period of 12 months in a row starting or ending in 2006? Yescheckbox checked
b. The physical presence test is based on the 12-month period fromfield contains 1-1-06 through 12-31-06
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? Yescheckbox checked
Part II: General Information:
4. Your foreign address (including country)field contains
5. Your occupationfield contains Secretary
6. Employer's namefield contains A B Insurance Company, Incorporated
7. Employer's United States address (including ZIP code)field contains
8. Employer's foreign addressfield contains
9. Employer is (check any that apply): a. A United States businesscheckbox checked
10a. If you filed Form 2555 or 2555-EZ after 1981, enter the last year you filed the form.field contains 2005
10c. Have you ever revoked the foreign earned income exclusion? Nocheckbox checked
11a. List your tax home(s) during 2006 and date(s) established.field contains Country Y 6-1-98
11b. Of what country are you a citizen/national?field contains United States
Part IV: Figure Your Foreign Earned Income Exclusion:
14. Enter the number of days in your qualifying period that fall within 2004field contains 366 days
15. Did you enter 365 on line 14? Yescheckbox checked
Enter 1.000field contains 1.000
16. Multiply line 13 by line 15field contains 80,000