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Begin by entering your name(s) and mailing address in the designated fields. Ensure that you include your Tax Identification Number (TIN) and contact information.
In the certification section, confirm that you are providing delinquent or amended income tax returns for the last three years. List the years and amounts of tax owed, including interest.
Indicate whether you were physically outside the U.S. for at least 330 full days in any of the last three years. Answer 'Yes' or 'No' for each year.
Provide a detailed narrative statement explaining your failure to report all income and submit required returns, including FBARs. This should include personal and financial background information.
Sign and date the form at the bottom. If filing jointly, ensure both spouses sign.
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