IRS Form 14653 "Certification by U.S. Person Residing Outside of the United States for Streamlined Foreign Offshore Procedures"

What Is IRS Form 14653?

This is a tax form that was released by the Internal Revenue Service (IRS) - a subdivision of the U.S. Department of the Treasury on October 1, 2017. As of today, no separate filing guidelines for the form are provided by the IRS.

Form Details:

  • A 3-page form available for download in PDF;
  • Actual and valid for filing 2021 taxes;
  • Editable, printable, and free;
  • Fill out the form in our online filing application.

Download a fillable version of IRS Form 14653 through the link below or browse more documents in our library of IRS Forms.

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Download IRS Form 14653 "Certification by U.S. Person Residing Outside of the United States for Streamlined Foreign Offshore Procedures"

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Department of the Treasury - Internal Revenue Service
14653
OMB Number
Form
Certification by U.S. Person Residing Outside of the United
1545-2241
(October 2017)
States for Streamlined Foreign Offshore Procedures
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
Amount of Tax I Owe Shown On
Interest
Total
(list years in order)
(Form 1040 or Form 1040X)
$0.00
$0.00
$0.00
Total
$0.00
$0.00
$0.00
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
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
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
14653
Catalog Number 67042A
www.irs.gov
Form
(Rev. 10-2017)
Department of the Treasury - Internal Revenue Service
14653
OMB Number
Form
Certification by U.S. Person Residing Outside of the United
1545-2241
(October 2017)
States for Streamlined Foreign Offshore Procedures
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
Amount of Tax I Owe Shown On
Interest
Total
(list years in order)
(Form 1040 or Form 1040X)
$0.00
$0.00
$0.00
Total
$0.00
$0.00
$0.00
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
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
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
14653
Catalog Number 67042A
www.irs.gov
Form
(Rev. 10-2017)
Page 2 of 3
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.
14653
Catalog Number 67042A
www.irs.gov
Form
(Rev. 10-2017)
Page 3 of 3
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
Name of Taxpayer
Date
(if joint certification)
(if joint certification)
For Estates Only
Signature of Fiduciary
Date
Title of Fiduciary
Name of Fiduciary
(e.g., executor or administrator)
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
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
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
14653
Catalog Number 67042A
www.irs.gov
Form
(Rev. 10-2017)
Page of 3