Form 1116
Department of the Treasury
Internal Revenue Service
(99)
Foreign Tax Credit
(Individual, Estate, or Trust)
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Attach to Form 1040, 1040NR, 1041, or 990-T.
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Information about Form 1116 and its separate instructions is at www.irs.gov/form1116.
OMB No. 1545-0121
2016
Attachment
Sequence No.
19
Name
Identifying number as shown on page 1 of your tax return
Use a separate Form 1116 for each category of income listed below. See Categories of Income in the instructions. Check only one box on each Form
1116. Report all amounts in U.S. dollars except where specified in Part II below.
a
Passive category income
b
General category income
c
Section 901(j) income
d
Certain income re-sourced by treaty
e
Lump-sum distributions
f Resident of (name of country)
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Note:If you paid taxes to only one foreign country or U.S. possession, use column A in Part I and line A in Part II. If you paid taxes to
more than one foreign country or U.S. possession, use a separate column and line for each country or possession.
Part I Taxable Income or Loss From Sources Outside the United States (for Category Checked Above)
Foreign Country or U.S. Possession
A B
C
Total
(Add cols. A, B, and C.)
g
Enter the name of the foreign country or U.S.
possession...........
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1a
Gross income from sources within country shown
above and of the type checked above (see
instructions):
1a
b
Check if line 1a is compensation for personal
services as an employee, your total
compensation from all sources is $250,000 or
more, and you used an alternative basis to
determine its source (see instructions) ..
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Deductions and losses (Caution: See instructions.):
2
Expenses definitely relatedto the income on line
1a (attach statement) .........
3
Pro rata share of other deductions not definitely
related:
a
Certain itemized deductions or standard deduction
(see instructions) ...........
b Other deductions (attach statement) .....
c Add lines 3a and 3b ..........
d Gross foreign source income (see instructions) .
e Gross income from all sources (see instructions) .
f Divide line 3d by line 3e (see instructions) ...
g Multiply line 3c by line 3f ........
4
Pro rata share of interest expense (see instructions):
a
Home mortgage interest (use the Worksheet for
Home Mortgage Interest in the instructions) ..
b Other interest expense .........
5 Losses from foreign sources .......
6 Add lines 2, 3g, 4a, 4b, and 5 .......
6
7
Subtract line 6 from line 1a. Enter the result here and on line 15, page 2 ..........
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7
Part II Foreign Taxes Paid or Accrued (see instructions)
Country
Credit is claimed
for taxes
(you must check one)
(h)
Paid
(i)
Accrued
(j) Date paid
or accrued
Foreign taxes paid or accrued
In foreign currency
Taxes withheld at source on:
(k) Dividends
(l) Rents
and royalties
(m) Interest
(n) Other
foreign taxes
paid or
accrued
In U.S. dollars
Taxes withheld at source on:
(o) Dividends
(p) Rents
and royalties
(q) Interest
(r) Other
foreign taxes
paid or
accrued
(s) Total foreign
taxes paid or
accrued (add cols.
(o) through (r))
A
B
C
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Add lines A through C, column (s). Enter the total here and on line 9, page 2........
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8
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11440U
Form 1116 (2016)