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Form 8833 Form Field Reference for TY2011

Form 8833, Treaty-Based Return Position Disclosure Under Section 6114 or 7701(b)

Field No.

Description

Line Ref.

 

0010

SSN or ITIN - 2009

 

0020

Residence Name Line 2

 

0030

Residence Street Address

 

0040

Residence City

 

0050

Residence State Abbreviation

 

0060

Residence Zip Code

 

0070

Residence Foreign State or Province

 

0080

Residence Foreign Postal Code

 

0090

Residence Foreign Country

 

0100

U.S. Name Line 2

 

0110

U.S. Street Address

 

0120

U.S. City

 

0130

U.S. State Abbreviation

 

0140

U.S. Zip Code

 

0150

Section 6114 Treaty-Based Return Position Box

 

0160

Reg 301.7701(b)-7 Treaty-Based Return Position Box

 

0170

U.S. Citizen/Resident or U.S. Incorporated Box

 

0180

Treaty Country Name

1a

0190

Treaty Article(s)

1b

0200

Internal Revenue Code Provision(s) Overruled/Modified

2

0210

Payer Name

3

0220

Payer TIN

3

0230

Payer Name Line 2

3

0240

Payer U.S. Street Address

3

0250

Payer U.S. City

3

0260

Payer U.S.State

3

0270

Payer U.S. Zip Code

3

0280

Treaty Provision(s) of Limitation on Benefits Article

4

0290

Explanation 1

5

0300

Explanation 2

5

0310

Explanation 3

5

0320

Explanation 4

5

0330

Explanation 5

5

0340

Explanation 6

5

0350

Explanation 7

5

0360

Explanation 8

5

0370

Explanation 9

5

0380

Explanation 10

5

0390

Explanation 11

5

0400

Explanation 12

5

0410

Explanation 13

5

0420

Explanation 14

5

0430

Explanation 15

5

0440

Explanation 16

5

0450

Explanation 17

5

0460

Explanation 18

5

0470

Explanation 19

5

0480

Explanation 20

5

0490

Explanation 21

5

0500

Explanation 22

5

0510

Explanation 23

5

0520

Explanation 24

5

0530

Explanation 25

5

0540

Explanation 26

5

0550

Explanation 27

5

0560

Explanation 28

5

Page Last Reviewed or Updated: 2012-08-03