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State
Country
Form  
2555-EZ
Department of the Treasury 
Internal Revenue Service
 (99) 
Foreign Earned Income Exclusion 
a
 
Attach to Form 1040. 
 
 
a
. 
OMB No. 1545-0074 
20
13
Attachment 
Sequence No. 
34A 
Name shown on Form 1040 
Your social security number 
You May Use  
This Form  
If You: 
• Are a U.S. citizen or a resident alien. 
• Earned wages/salaries in a foreign country. 
• Had total foreign earned income                  
of $97,600 or less.
• Are filing a calendar year return that  covers 
a 12-month period. 
And You: 
• Do not have self-employment income. 
• Do not have business/moving expenses. 
• Do not claim the foreign housing  
exclusion or deduction. 
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 instructions)? 
..............................
Yes
No
• If you answered “Yes,” you meet this test. Fill in line 1b and then go to line 3. 
b 
Enter the date your bona fide residence began 
a
, and ended (see instructions) 
a
 
. 
2      Physical Presence Test 
a 
Were you physically present in a foreign country or countries for at least 330 full days during— 
{
 
any other period of 12 months in a row starting or ending in 2013? 
}
.............
Yes
No
• If you answered “Yes,” you meet this test. Fill in line 2b and then go to line 3. 
Bona Fide Residence Test above. 
b 
The physical presence test is based on the 12-month period from 
a
through 
a
. 
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
No
• If you answered “Yes,” you can take the exclusion. Complete Part II below and then go to page 2. 
Part II 
General Information 
4
  Your foreign address (including country) 
5
  Your occupation 
6
  Employer’s name 
7
  
Employer’s U.S. address (including ZIP code)
 
8
  Employer’s foreign address 
9 
Employer is (check any that apply): 
a 
A U.S. business 
...................................
b 
A foreign business 
..................................
c 
Other (specify) 
a
10 
a 
If you previously filed Form 2555 or 2555-EZ, enter the last year you filed the form. 
a
b 
If you did not previously file Form 2555 or 2555-EZ, check here 
a
and go to line 11a now. 
c 
Have you ever revoked the foreign earned income exclusion? 
...............
Yes
No
d 
If you answered “Yes,” enter the tax year for which the revocation was effective. 
a
11a 
List your tax home(s) during 2013 and date(s) established. 
a
b 
Of what country are you a citizen/national? 
a
For Paperwork Reduction Act Notice, see the Form 1040 instructions. 
Cat. No. 13272W 
Form  
2555-EZ 
 (2013) 
City
Country Code
Address
Address
Addr
Addr2
City
Prov
Postal
Country
Addr
City
ZIP
 Information about Form 2555-EZ and its separate instructions is at www.irs.gov/form2555ez
• If you answered “No,” you do not meet this test. Go to line 2 to see if you meet the Physical Presence Test. 
2013 or
• If you answered “No,” you do not meet this test. You cannot take the exclusion unless you meet the 
• If you answered “No,” you cannot take the exclusion. Do not file this form. 
----------------Page (0) Break----------------
Days Present in the United States
Figure Your Foreign Earned Income Exclusion 
Form 2555-EZ (2013) 
Page  
2 
Part III 
Complete this part if you were in the
 
United States or its possessions during 2013. 
12     
(a) 
Date arrived in U.S. 
(b) 
Date left U.S. 
(c) 
Number of days
 
in U.S. on business 
(d) 
Income earned in U.S.
 
on business (attach computation) 
 
 
 
 
                                                                                                                                                                                                                                               
Part IV 
13 
Maximum foreign earned income exclusion 
..................
13 
14 
Enter the number of days in your qualifying period that fall within 2013      .
14 
days 
15 
Did you enter 365 on line 14? 
a decimal (rounded to at least three places). 
}
.............
15 
×
. 
16 
Multiply line 13 by line 15 
........................
16 
17 
 
Enter, in U.S. dollars, the total foreign earned income you earned and received in 2013 (see 
instructions). Be sure to include this amount on Form 1040, line 7 
...........
17 
18 
 
 
from your income to arrive at total income on Form 1040, line 22  .
.......... 
a
18 
Form  
2555-EZ 
 (2013) 
$97,600
Foreign earned income exclusion. Enter the smaller of line 16 or line 17 here and in parentheses 
on Form 1040, line 21. Next to the amount enter •2555-EZ.Ž On Form 1040, subtract this amount 
No. Divide line 14 by 365 and enter the result as 
Yes. Enter “1.000.” 
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