Summary: ATTACHMENT TO FORM 8233
(For use by students of Indonesia who are claiming Tax Treaty exemption).
1. I was a resident Indonesia on the date of my arrival in the United States. I am not a
United States citizen. I have not been lawfully accorded the privilege of residing
permanently in the United States as an immigrant.
2. I am temporarily in the United States solely for the purpose of study at The
University of Michigan.
3. I will receive compensation for services performed in the United States. This
compensation qualifies for exemption from withholding of federal income tax
under the tax treaty between the United States and Indonesia in an amount not in
excess of $2,000 for my tax year, provided such services are performed in
connection with my studies or are necessary for my maintenance.
4. I arrived in the United States on (date of last arrival in the U.S. prior
to beginning study at The University of Michigan). The treaty exemption is
available only for compensation paid during a period of five tax years beginning
with the tax year that includes my arrival date.
Under penalties of perjury, I declare that the above statements are true, correct, and
Soc. Sec. # Date:________________________