IRS Form 8802 "Application for United States Residency Certification"

What Is IRS Form 8802?

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 November 1, 2018. Check the official IRS-issued instructions before completing and submitting the form.

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 8802 through the link below or browse more documents in our library of IRS Forms.

ADVERTISEMENT
ADVERTISEMENT

Download IRS Form 8802 "Application for United States Residency Certification"

1253 times
Rate (4.8 / 5) 63 votes
8802
Application for United States
Form
Residency Certification
OMB No. 1545-1817
(Rev. November 2018)
Department of the Treasury
See separate instructions.
Internal Revenue Service
Important. For applicable user fee information, see the Instructions for Form 8802.
For IRS use only:
Pmt Amt $
.
Additional request (see instructions)
Foreign claim form attached
Deposit Date:
/
/
Date Pmt Vrfd:
/
/
Electronic payment confirmation no.
Applicant’s name
Applicant’s U.S. taxpayer identification number
If a joint return was filed, spouse’s name (see instructions)
If a joint return was filed, spouse’s U.S. taxpayer
identification number
If a separate certification is needed for spouse, check here
1
Applicant’s name and taxpayer identification number as it should appear on the certification if different from above
2
Applicant’s address during the calendar year for which certification is requested, including country and ZIP or postal code. If a P.O.
box, see instructions.
3a
Mail Form 6166 to the following address:
b
Appointee Information (see instructions):
Appointee Name
CAF No.
(
)
(
)
Phone No.
Fax No.
4
Applicant is (check appropriate box(es)):
a
Individual. Check all applicable boxes.
U.S. citizen
U.S. lawful permanent resident (green card holder)
Sole proprietor
Other U.S. resident alien. Type of entry visa
Current nonimmigrant status
and date of change (see instructions)
Dual-status U.S. resident (see instructions). From
to
to
Partial-year Form 2555 filer (see instructions). U.S. resident from
b
Partnership. Check all applicable boxes.
U.S.
Foreign
LLC
c
Trust. Check if:
Grantor (U.S.)
Simple
Rev. Rul. 81-100 Trust
IRA (for Individual)
Grantor (foreign)
Complex
Section 584
IRA (for Financial Institution)
d
Estate
e
Corporation. If incorporated in the United States only, go to line 5. Otherwise, continue.
Check if:
Section 269B
Section 943(e)(1)
Section 953(d)
Section 1504(d)
Country or countries of incorporation
If a dual-resident corporation, specify other country of residence
If included on a consolidated return, attach page 1 of Form 1120 and Form 851.
f
S corporation
g
Employee benefit plan/trust. Plan number, if applicable
Check if:
Section 401(a)
Section 403(b)
Section 457(b)
h
Exempt organization. If organized in the United States, check all applicable boxes.
Section 501(c)
Section 501(c)(3)
Governmental entity
Indian tribe
Other (specify)
i
Disregarded entity. Check if:
LLC
LP
LLP
Other (specify)
j
Nominee applicant (must specify the type of entity/individual for whom the nominee is acting)
8802
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Form
(Rev. 11-2018)
Cat. No. 10003D
8802
Application for United States
Form
Residency Certification
OMB No. 1545-1817
(Rev. November 2018)
Department of the Treasury
See separate instructions.
Internal Revenue Service
Important. For applicable user fee information, see the Instructions for Form 8802.
For IRS use only:
Pmt Amt $
.
Additional request (see instructions)
Foreign claim form attached
Deposit Date:
/
/
Date Pmt Vrfd:
/
/
Electronic payment confirmation no.
Applicant’s name
Applicant’s U.S. taxpayer identification number
If a joint return was filed, spouse’s name (see instructions)
If a joint return was filed, spouse’s U.S. taxpayer
identification number
If a separate certification is needed for spouse, check here
1
Applicant’s name and taxpayer identification number as it should appear on the certification if different from above
2
Applicant’s address during the calendar year for which certification is requested, including country and ZIP or postal code. If a P.O.
box, see instructions.
3a
Mail Form 6166 to the following address:
b
Appointee Information (see instructions):
Appointee Name
CAF No.
(
)
(
)
Phone No.
Fax No.
4
Applicant is (check appropriate box(es)):
a
Individual. Check all applicable boxes.
U.S. citizen
U.S. lawful permanent resident (green card holder)
Sole proprietor
Other U.S. resident alien. Type of entry visa
Current nonimmigrant status
and date of change (see instructions)
Dual-status U.S. resident (see instructions). From
to
to
Partial-year Form 2555 filer (see instructions). U.S. resident from
b
Partnership. Check all applicable boxes.
U.S.
Foreign
LLC
c
Trust. Check if:
Grantor (U.S.)
Simple
Rev. Rul. 81-100 Trust
IRA (for Individual)
Grantor (foreign)
Complex
Section 584
IRA (for Financial Institution)
d
Estate
e
Corporation. If incorporated in the United States only, go to line 5. Otherwise, continue.
Check if:
Section 269B
Section 943(e)(1)
Section 953(d)
Section 1504(d)
Country or countries of incorporation
If a dual-resident corporation, specify other country of residence
If included on a consolidated return, attach page 1 of Form 1120 and Form 851.
f
S corporation
g
Employee benefit plan/trust. Plan number, if applicable
Check if:
Section 401(a)
Section 403(b)
Section 457(b)
h
Exempt organization. If organized in the United States, check all applicable boxes.
Section 501(c)
Section 501(c)(3)
Governmental entity
Indian tribe
Other (specify)
i
Disregarded entity. Check if:
LLC
LP
LLP
Other (specify)
j
Nominee applicant (must specify the type of entity/individual for whom the nominee is acting)
8802
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Form
(Rev. 11-2018)
Cat. No. 10003D
2
Form 8802 (Rev. 11-2018)
Page
Applicant name:
5
Was the applicant required to file a U.S. tax form for the tax period(s) on which certification will be based?
Yes.
Check the appropriate box for the form filed and go to line 7.
990
990-T
1040
1041
1065
1120
1120S
3520-A
5227
5500
Other (specify)
No.
Attach explanation (see instructions). Check applicable box and go to line 6.
Minor child
QSub
U.S. DRE
Foreign DRE
Section 761(a) election
FASIT
Foreign partnership
Other
6
Was the applicant’s parent, parent organization or owner required to file a U.S. tax form? (Complete this line only if you checked
“No” on line 5.)
Yes.
Check the appropriate box for the form filed by the parent.
990
990-T
1040
1041
1065
1120
1120S
5500
Other (specify)
Parent’s/owner’s name and address
and U.S. taxpayer identification number
No.
Attach explanation (see instructions).
7
Calendar year(s) for which certification is requested.
Note. If certification is for the current calendar year or a year for which a tax return is not yet required to be filed, a penalties
of perjury statement from Table 2 of the instructions must be entered on line 10 or attached to Form 8802 (see instructions).
8
Tax period(s) on which certification will be based (see instructions).
9
Purpose of certification. Must check applicable box (see instructions).
Income tax
VAT (specify NAICS codes)
Other (must specify)
10
Enter penalties of perjury statements and any additional required information here (see instructions).
Sign
Under penalties of perjury, I declare that I have examined this application and accompanying attachments, and to the best of my knowledge and belief,
they are true, correct, and complete. If I have designated a third party to receive the residency certification(s), I declare that the certification(s) will be used
here
only for obtaining information or assistance from that person relating to matters designated on line 9.
Applicant’s signature (or individual authorized to sign for the applicant)
Applicant’s daytime phone no.:
Keep a
copy for
your
Signature
Date
records.
Name and title (print or type)
Spouse’s signature. If a joint application, both must sign.
Name (print or type)
8802
Form
(Rev. 11-2018)
3
Worksheet for U.S. Residency Certification Application
Form 8802 (Rev. 11-2018)
Page
Applicant Name
Applicant TIN
Appointee Name (If Applicable)
Calendar year(s) for which certification is requested (must be the same year(s) indicated on line 7)
11
Enter the number of certifications needed in the column to the right of each country for which certification is requested.
Note. If you are requesting certifications for more than one calendar year per country, enter the total number of certifications for all years for
each country (see instructions).
Column A
Column B
Column C
Column D
Country
CC
#
Country
CC
#
Country
CC
#
Country
CC
#
Armenia
AM
Finland
FI
Latvia
LG
South Africa
SF
Australia
AS
France
FR
Lithuania
LH
Spain
SP
Austria
AU
Georgia
GG
Luxembourg
LU
Sri Lanka
CE
Azerbaijan
AJ
Germany
GM
Mexico
MX
Sweden
SW
Bangladesh
BG
Greece
GR
Moldova
MD
Switzerland
SZ
Barbados
BB
Hungary
HU
Morocco
MO
Tajikistan
TI
Belarus
BO
Iceland
IC
Netherlands
NL
Thailand
TH
Belgium
BE
India
IN
New Zealand
NZ
Trinidad and Tobago
TD
Bermuda
BD
Indonesia
ID
Norway
NO
Tunisia
TS
Bulgaria
BU
Ireland
EI
Pakistan
PK
Turkey
TU
Canada
CA
Israel
IS
Philippines
RP
Turkmenistan
TX
China
CH
Italy
IT
Poland
PL
Ukraine
UP
Cyprus
CY
Jamaica
JM
Portugal
PO
United Kingdom
UK
Czech Republic
EZ
Japan
JA
Romania
RO
Uzbekistan
UZ
Denmark
DA
Kazakhstan
KZ
Russia
RS
Venezuela
VE
Egypt
EG
Korea, South
KS
Slovak Republic
LO
Estonia
EN
Kyrgyzstan
KG
Slovenia
SI
Column A - Total
Column B - Total
Column C - Total
Column D - Total
12 Enter the total number of certifications requested (add columns A, B, C, and D of line 11) .
.
.
.
.
.
.
.
.
.
8802
Form
(Rev. 11-2018)
Page of 3