Homepage 14653 Form

14653 Sample

Form 14653

(October 2017)

Department of the Treasury - Internal Revenue Service

Certification by U.S. Person Residing Outside of the United

States for Streamlined Foreign Offshore Procedures

OMB Number

1545-2241

Name(s) of taxpayer(s)

TIN(s) of taxpayer(s)

Telephone number

Mailing address

City

State

ZIP code

Note: If this certification is a joint certification, the statements will be considered made on behalf of both spouses, even though the pronoun "I" is used. If spouses submitting a joint certification have different reasons for their failure to report all income, pay all tax, and submit all required information returns, including FBARs, they must state their individual reasons separately in the required statement of facts.

Certification

I am providing delinquent or amended income tax returns, including all required information returns, for each of the most recent 3 years for which the U.S. tax return due date (or properly applied for extended due date) has passed. The tax and interest I owe for each year are as follows

Year

(list years in order)

Amount of Tax I Owe Shown On

(Form 1040 or Form 1040X)

Interest

Total

Total

Note: Your payment should equal the total tax and interest due for all three years. You may receive a balance due notice or a refund if the tax or interest is not calculated correctly.

I failed to report income from one or more foreign financial assets during the above period.

I meet all the other eligibility requirements for the Streamlined Foreign Offshore procedures.

If I failed to timely file correct and complete FBARs for any of the last six years, I have now electronically filed those FBARs.

I agree to retain all records related to my income and assets during the period covered by my delinquent or amended returns until three years from the date of this certification. If I was required to file delinquent FBARs in accordance with these procedures, I also agree to retain all records (including, but not limited to, account statements) related to my foreign financial accounts until six years from the date of this certification. Upon request, I agree to provide all such records to the Internal Revenue Service.

My failure to report all income, pay all tax, and submit all required information returns, including FBARs, was due to non-willful conduct. I understand that non-willful conduct is conduct that is due to negligence, inadvertence, or mistake or conduct that is the result of a good faith misunderstanding of the requirements of the law.

I acknowledge the possibility that amended income tax returns I am submitting under the Streamlined Foreign Offshore Procedures may report income for tax years beyond the three-year assessment limitations period under I.R.C. § 6501(a). Other assessment limitations periods in I.R.C. § 6501 may allow the Internal Revenue Service to assess and collect tax. If I seek a refund for any tax or interest paid for the omitted income that I am reporting on my amended income tax returns because I feel that my payments were made beyond the assessment limitations period, I understand that I will forfeit the favorable terms of the Streamlined Procedures.

I recognize that if the Internal Revenue Service receives or discovers evidence of willfulness, fraud, or criminal conduct, it may open an examination or investigation that could lead to civil fraud penalties, FBAR penalties, information return penalties, or even referral to Criminal Investigation.

I meet the non-residency requirements for the Streamlined Foreign Offshore procedures as disclosed below.

Note: Both spouses filing a joint certification must meet the non-residency requirements.

Complete one of the following (two) sections regarding your residency status

If you are a U.S. citizen or lawful permanent resident (i.e., “green card holder”), complete this section:

For the covered tax period, indicate whether you were physically outside the United States for each year. You must have been physically outside the U.S. for at least 330 full days in any one or more of the most recent three years for which the U.S. tax return due date (or properly applied for extended due date) has passed, and you must not have had a U.S. abode. For more information on the meaning of “abode” see IRS Publication 54.

Catalog Number 67042A

www.irs.gov

Form 14653 (Rev. 10-2017)

Page of

I was physically outside the United States for at least 330 full days (answer Yes or No for each year)

Year

Yes

No

Both spouses filing a joint certification must meet the non-residency requirement. If the number of days physically outside of the U.S. differs for each spouse, disclose that on the chart above or in an attachment to this certification.

If you are not a U.S. citizen or lawful permanent resident, complete this section:

If you are not a U.S. citizen or a lawful permanent resident, please attach to this certification your computation showing that you did not meet the substantial presence test under I.R.C. sec. 7701(b)(3). Your computation must disclose the number of days you were present in the U.S. for the three years included in your Streamlined Foreign Offshore Procedures submission and the previous two years. If you do not attach a complete computation showing that you did not meet the substantial presence test, your submission will be considered incomplete and your submission will not qualify for the Streamlined Foreign Offshore Procedures.

Both spouses filing a joint certification must meet the non-residency requirement. If the number of days inside the U.S. differs for each spouse, disclose that on the chart above or in an attachment to this certification.

Note: You must provide specific facts on this form or on a signed attachment explaining your failure to report all income, pay all tax, and submit all required information returns, including FBARs. Any submission that does not contain a narrative statement of facts will be considered incomplete and will not qualify for the streamlined penalty relief.

Provide specific reasons for your failure to report all income, pay all tax, and submit all required information returns, including FBARs. Include the whole story including favorable and unfavorable facts. Specific reasons, whether favorable or unfavorable to you, should include your personal background, financial background, and anything else you believe is relevant to your failure to report all income, pay all tax, and submit all required information returns, including FBARs. Additionally, explain the source of funds in all of your foreign financial accounts/assets. For example, explain whether you inherited the account/asset, whether you opened it while residing in a foreign country, or whether you had a business reason to open or use it. And explain your contacts with the account/asset including withdrawals, deposits, and investment/ management decisions. Provide a complete story about your foreign financial account/asset. If you relied on a professional advisor, provide the name, address, and telephone number of the advisor and a summary of the advice. If married taxpayers submitting a joint certification have different reasons, provide the individual reasons for each spouse separately in the statement of facts. The field below will automatically expand to accommodate your statement of facts.

Catalog Number 67042A

www.irs.gov

Form 14653 (Rev. 10-2017)

Page of

Under penalties of perjury, I declare that I have examined this certification and all accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete.

Signature of Taxpayer

Name of Taxpayer

Date

 

 

 

Signature of Taxpayer (if joint certification)

Name of Taxpayer (if joint certification)

Date

 

 

 

For Estates Only

Signature of Fiduciary

Date

 

 

Title of Fiduciary (e.g., executor or administrator)

Name of Fiduciary

For Paid Preparer Use Only (the signature of taxpayer(s) or fiduciary is required even if this form is signed by a paid preparer)

Signature of Preparer

Name of Preparer

 

 

Date

 

 

 

 

 

Firm’s name

 

 

 

Firm’s EIN

 

 

 

 

 

Firm’s address

City

 

State

ZIP code

 

 

 

 

 

Telephone number

PTIN

 

 

Check if

 

 

 

 

 

 

 

 

Self-Employed

 

 

 

 

Do you want to allow another person to discuss this form with the IRS

Yes (complete information below)

No

 

 

 

 

Designee’s name

 

 

Telephone number

 

 

 

 

 

Privacy Act and Paperwork Reduction Notice

We ask for the information on this certification by U.S. person residing in the United States for streamlined domestic offshore procedures to carry out the Internal Revenue laws of the United States. Our authority to ask for information is sections 6001, 6109, 7801, 7803 and the regulations thereunder. This information will be used to determine and collect the correct amount of tax under the terms of the streamlined filing compliance program. You are not required to apply for participation in the streamlined filing compliance program. If you choose to apply, however, you are required to provide all the information requested on the streamlined certification. You are not required to provide the information requested on a document that is subject to the Paperwork Reduction Act unless the document displays a valid OMB control number. Books or records relating to a document or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103. Section 6103, however, allows or requires the Internal Revenue Service to disclose or give this information to others as described in the Internal Revenue Code. For example, we may disclose this information to the Department of Justice to enforce the tax laws, both civil and criminal, and to cities, states, the District of Columbia, and U.S. commonwealths or possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. Failure to provide this information may delay or prevent processing your application. Providing false information may subject you to penalties. The time needed to complete and submit the streamlined certification will vary depending on individual circumstances. The estimated average time is: 8 hours

Catalog Number 67042A

www.irs.gov

Form 14653 (Rev. 10-2017)

Instructions on Utilizing 14653

Completing Form 14653 is an important step for U.S. persons residing outside the United States who wish to participate in the Streamlined Foreign Offshore Procedures. This form requires careful attention to detail to ensure all necessary information is accurately provided. Below are the steps to guide you through the process of filling out the form.

  1. Provide Taxpayer Information: Enter the names of all taxpayers involved, including any joint filers. Include the Tax Identification Numbers (TINs) for each taxpayer, along with a contact telephone number and mailing address, including city, state, and ZIP code.
  2. Complete the Certification Section: Confirm that you are submitting delinquent or amended income tax returns for the last three years. Clearly list the amount of tax owed and any interest for each year in the designated fields.
  3. Confirm Non-Residency: Indicate whether you were physically outside the United States for at least 330 days during the relevant years. Answer "Yes" or "No" for each year.
  4. Attach Required Documentation: If you are not a U.S. citizen or lawful permanent resident, include a computation showing that you did not meet the substantial presence test. Ensure this is attached to your submission.
  5. Provide a Statement of Facts: Write a detailed narrative explaining your reasons for failing to report all income and submit required returns. Include personal and financial background, the source of funds in foreign accounts, and any reliance on professional advice.
  6. Sign and Date the Form: Each taxpayer must sign and date the form. If it is a joint certification, both taxpayers must provide their signatures and dates.
  7. Complete Preparer Information (if applicable): If a paid preparer assists you, they must complete their section, including signature, firm name, and contact information.
  8. Review the Form: Double-check all entries for accuracy. Ensure that all required sections are filled out completely to avoid delays in processing.

After completing these steps, submit the form according to the instructions provided by the IRS. Ensure you keep a copy of the completed form and all supporting documents for your records. This will help you maintain compliance and provide necessary information if requested by the IRS in the future.

Misconceptions

  • Misconception 1: The 14653 form is only for individuals who intentionally avoided reporting income.
  • This form is designed for those who can demonstrate that their failure to report was due to non-willful conduct, such as negligence or misunderstanding of the law.

  • Misconception 2: Submitting the 14653 form guarantees immunity from penalties.
  • While the form may help reduce penalties under the Streamlined Foreign Offshore Procedures, it does not guarantee immunity. If the IRS finds evidence of willfulness or fraud, penalties may still apply.

  • Misconception 3: All taxpayers can use the 14653 form regardless of their residency status.
  • Only U.S. citizens or lawful permanent residents residing outside the U.S. are eligible to use this form. Both spouses must also meet the non-residency requirements if filing jointly.

  • Misconception 4: The 14653 form can be submitted without a narrative statement of facts.
  • A complete narrative explaining the reasons for failing to report income is essential. Without this, the submission will be considered incomplete and may not qualify for relief.

  • Misconception 5: There is no need to retain records after submitting the 14653 form.
  • Taxpayers must keep all relevant records for three years after certification and six years if FBARs were required. This is crucial for compliance and potential IRS requests.

  • Misconception 6: Filing the 14653 form is the same as filing a regular tax return.
  • The 14653 form is specifically for those seeking streamlined procedures for previously unreported income, and it requires additional documentation and explanations beyond a standard tax return.

  • Misconception 7: The IRS will not review the information provided on the 14653 form.
  • The IRS actively reviews submissions for accuracy and completeness. Any discrepancies or incomplete information can lead to further scrutiny or penalties.

Documents used along the form

The Form 14653 is an important document for U.S. persons living abroad who need to rectify their tax situation under the Streamlined Foreign Offshore Procedures. When submitting this form, there are several other documents that may be required or beneficial to include. Below is a list of these forms and documents, along with a brief description of each.

  • Form 1040: This is the standard individual income tax return form used by U.S. citizens and residents to report their income, calculate taxes owed, and claim refunds. It is essential to submit this form for the tax years in question.
  • Form 1040X: This form is used to amend a previously filed tax return. If there were errors or omissions in the original Form 1040, this form allows taxpayers to correct those mistakes and report the correct information.
  • FBAR (FinCEN Form 114): U.S. persons with foreign bank accounts exceeding certain thresholds must file this form annually. It reports foreign financial accounts to the U.S. Treasury and is crucial for compliance with the Foreign Bank Account Reporting requirements.
  • Durable Power of Attorney: A vital document that allows individuals to authorize someone to handle their financial and healthcare decisions, even during incapacitation. For comprehensive information, visit All Washington Forms.
  • Form 8938: This form is required for reporting specified foreign financial assets. Taxpayers must file it if their foreign assets exceed certain thresholds, making it an important part of the overall compliance process.
  • Statement of Facts: This narrative explains the reasons for failing to report all income or submit required forms. It should include personal and financial backgrounds and any relevant circumstances that led to the oversight.
  • Supporting Documentation: This includes any records that substantiate the information provided in the tax returns and statements. Examples are bank statements, account statements, and documentation regarding the source of funds in foreign accounts.

In conclusion, when submitting Form 14653, it is crucial to include these additional documents to ensure a complete and compliant application. Each of these forms plays a role in demonstrating eligibility for the Streamlined Foreign Offshore Procedures and helps to clarify the taxpayer's situation to the IRS.