Foreign Tax Credit OMB No. 154S-0121 Forth 1116 Department of the Treasury Memel Reverue Semce (99) Name (Individual. Estate. or Trust) ► Attach to Form 1040. 1040NR. 1041. or 990-T. Is. Go to www.irs.gov/Fortn1116 for instructions and the latest information. 2017 Attachment Sequence No. 19 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. Et 0 Passive category income CO Section 9010) income eO Lump-sum distributions bO General category income dO Certain income re-sourced by treaty f Resident of (name of country) ► 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. Taxable Income or Loss From Sources Outside the United States (for Cateaory Checked Abovel 9 Enter the name of the foreign country or U S. possession P. 1a Gross income from sources within country shown above and of the type checked above (see instructions): b Check if line la is compensation for personal services as an employee, your total compensation from all sources is 5250.000 or more, and you used an alternative basis to determine its source (see instructions) . . lir. 0 Foreign Country or U.S. Possession Total A B C (Add cols. A. B and C.) la Deductions and losses (Caution: See instructions.): 2 Expenses definitely related to the income on line I a (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)