Form 8833(Rev. September 2017) Department of the Treasury Internal Revenue Service Treaty-Based Return Position Disclosure Under Section 6114 or 7701(b)Attach to your tax return. Go to www.irs.gov/Form8833 for the latest information. OMB No. 1545-1354 Attach a separate Form 8833 for each treaty-based return position taken. Failure to disclose a treaty-based return position may result in a penalty of $1,000 ($10,000 in the case of a C corporation) (see section 6712). Name U.S. taxpayer identifying number Reference ID number, if any (see instructions) Address in country of residence Address in the United States Check one or both of the following boxes as applicable. 225The taxpayer is disclosing a treaty-based return position as required by section 6114 ............. 225The taxpayer is a dual-resident taxpayer and is disclosing a treaty-based return position as required byRegulations section 301.7701(b)-7 .............................. Note: If the taxpayer is a dual-resident taxpayer and a long-term resident, by electing to be treated as a resident of a foreign country for purposes of claiming benefits under an applicable income tax treaty, the taxpayer will be deemed to have expatriated pursuant to section 877A. For more information, see the instructions.Check this box if the taxpayer is a U.S. citizen or resident or is incorporated in the United States .......... 1 Enter the specific treaty position relied on: a Treaty country b Article(s) 2 List the Internal Revenue Code provision(s) overruled or modified by the treaty-based return position 3 Name, identifying number (if available to the taxpayer), and address in the United States of the payor of the income (if fixed or determinable annual or periodical). See instructions. 4 List the provision(s) of the limitation on benefits article (if any) in the treaty that the taxpayer relies on to prevent applicationof that article 5 Is the taxpayer disclosing a treaty-based return position for which reporting is specifically required pursuant to Regulations section 301.6114-1(b)?....................... Yes No If 223Yes,224 enter the specific subsection(s) of Regulations section 301.6114-1(b) requiring reporting....Also include the information requested in line 6. 6 Explain the treaty-based return position taken. Include a brief summary of the facts on which it is based. Also, list the nature and amount (or a reasonable estimate) of gross receipts, each separate gross payment, each separate gross income item, or other item (as applicable) for which the treaty benefit is claimed For Paperwork Reduction Act Notice, see the instructions. Cat. No. 14895L Form 8833 (Rev. 9-2017) American LegalNet, Inc. www.FormsWorkFlow.com [This page left blank intentionally] American LegalNet, Inc. www.FormsWorkFlow.com Form 8833 (Rev. 9-2017) Page 3 Section references are to the Internal Revenue Code unless otherwise noted. Future DevelopmentsFor the latest information about developments related to Form 8833 and its instructions, such as legislation enacted after they were published, go to IRS.gov/Form8833.General Instructions Purpose of Form Form 8833 must be used by taxpayers to make the treaty-based return position disclosure required by section 6114 and the regulations thereunder (Regulations section 301.6114-1). The form must also be used by dual-resident taxpayers (defined later) to make the treaty-based return position disclosure required by Regulations section 301.7701(b)-7. A separate form is required annually for each treaty-based return position taken by the taxpayer, although a taxpayer may treat payments or income items of the same type received from the same payor as a single item for reporting purposes.Who Must File Generally, a taxpayer who takes a treaty-based return position must disclose that position, unless reporting is specifically waived. See Exceptions from reporting below. A taxpayer takes a treaty-based return position by maintaining that a treaty of the United States overrules or modifies a provision of the Internal Revenue Code and thereby causes (or potentially causes) a reduction of tax on the taxpayer222s tax return. For these purposes, a treaty includes, but is not limited to, an income tax treaty; estate and gift tax treaty; or friendship, commerce, and navigation treaty. Reporting specifically required. Regulations section 301.6114-1(b) specifically requires reporting on a Form 8833 for the following treaty-based return positions. Note that this is not an exhaustive list of all positions that are reportable on a Form 8833 and that some specifically reportable positions are waived in certain circumstances under Regulations section 301.6114-1(c). 225That a nondiscrimination provision ofthe treaty prevents the application of an otherwise applicable Code provision, other than with respect to making an election under section 897(i);225That a treaty reduces or modifies thetaxation of gain or loss from the disposition of a U.S. real property interest;225That a treaty reduces or modifies thebranch profits tax (section 884(a)) or the tax on excess interest (section 884(f)(1)(B));225That a treaty exempts from tax orreduces the rate of tax on dividends or interest paid by a foreign corporation that are U.S.-sourced under section 861(a)(2)(B) or section 884(f)(1)(A);225That a treaty exempts from tax orreduces the rate of tax on fixed or determinable annual or periodical (FDAP) income that a foreign person receives from a U.S. person, but only if: (1) The amount is not properly reported on Form 1042-S and the foreign person is: (a) a controlled foreign corporation (as defined in section 957) in which the U.S. person is a U.S. shareholder (as defined in section 951(b)); (b) a foreign corporation that is controlled by a U.S. person within the meaning of section 6038; (c) a foreign corporation that is a 25-percent shareholder of the U.S. person under section 6038A; or (d) a foreign related party, as defined under section 6038A(c)(2)(B);(2) The foreign person is related to the payor under section 267(b) or section 707(b) and receives income exceeding $500,000, in the aggregate, from the payor and the treaty contains a limitation on benefits article; or(3) The treaty imposes additional conditions for the entitlement of treaty benefits (for example, the treaty requires the foreign corporation claiming a preferential rate on dividends to meet ownership percentage and ownership period requirements);225That income effectively connected witha U.S. trade or business of a taxpayer is not attributable to a permanent establishment or a fixed base in the United States;225That a treaty modifies the amount ofbusiness profits of a taxpayer attributable to a permanent establishment or a fixed base in the United States;225That a treaty alters the source of anyitem of income or deduction (unless the taxpayer is an individual);225That a treaty grants a credit for aforeign tax which is not allowed by the Code; 225That the residency of an individual isdetermined under a treaty and apart from the Code. See Dual-resident taxpayer below.Exceptions from reporting. Regulations section 301.6114-1(c) waives reporting on a Form 8833 for certain treaty-based return positions. In some instances, the waiver narrowly applies to exempt from reporting a treaty position that is specifically reportable, and thus careful review of the regulations is advised. In addition, some waivers do not apply to positions that are specifically required to be reported under these form instructions. See Reporting specifically required by Form 8833 instructions, later.Positions for which reporting is waived include, but are not limited to, the following. See Regulations section 301.6114-1(c) for other waivers from reporting.225That a treaty reduces or modifies thetaxation of income derived by an individual from dependent personal services, pensions, annuities, social security, and other public pensions, as well as income derived by artists, athletes, students, trainees, or teachers;225That a Social Security TotalizationAgreement or Diplomatic or Consular Agreement reduces or modifies the income of a taxpayer;225That a treaty exempts a taxpayer fromt