Residency Change Intake Form

Residency Change Intake Form

Please provide detailed information about your residency change, addresses, tax details, physical presence, connections, employment, and sign to confirm accuracy.
General Information
Name

First NameLast Name
Date bona fide residence began or ended

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Residency change type
U.S. possession involved
Previous and New Addresses
Previous U.S. or Possession Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date Moved Into Previous Address

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Moved Out of Previous Address

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
New U.S. or Possession Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date Moved Into New Address

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
State or Territory for Previous Address
State or Territory for New Address
Additional Address Details
Tax Filing Information
Tax year
Filing status
For this tax year, did you file as a U.S. resident or nonresident?
Prior-year residency status before this change
Was your change of residence for the entire year or only part of the year?
Physical Presence Details
Number of days spent in the U.S. during the year
Number of days spent in other countries during the year
Number of days spent in the possession during the year
Tax Home Determination
Where was your tax home located during the year?
Please explain the facts supporting your tax home determination.
Expanded Closer Connection Factors
Where are you registered to vote?
Where was your driver's license issued?
Where are your primary bank accounts maintained?
Where are your main memberships maintained?
Where is your personal property primarily located?
Travel details
Income Sourcing Breakdown
Which income sources should be broken out by location?

Other
Please describe where each income source is earned or sourced.
Do you need to file a U.S. return for this year?
Do you need to file a possession return for this year?
Do you acknowledge that penalties may apply if Form 8898 is not filed when required?
Explanation of absences or movement between locations
Closer Connection Questions
Where was your principal home located for most of the year?
Do you have family ties in the United States?
If you do not have family ties in the United States, briefly explain where your closest family ties are located.
Which of the following best describe your personal ties?
Which of the following best describe your social, political, or business ties?

Other
If you selected no relevant ties in any category, explain where your main social, political, or business ties are located and why.
Employment and Income Sourcing
Primary employer location

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Type(s) of income earned

Other
Is any income sourced in the possession or in the U.S.?
Additional income sources
Comments and Signature
Comments:
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Residency Change Intake Form

General Information

Previous and New Addresses

Tax Filing Information

Physical Presence Details

Tax Home Determination

Expanded Closer Connection Factors

Income Sourcing Breakdown

Closer Connection Questions

Employment and Income Sourcing

Comments and Signature