Summary: ATTACHMENT TO FORM 8233
(For use by students of Belgium and Iceland who are claiming Tax Treaty exemption).
1. I was a resident of __________________________ (insert name of country) 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
2. I am temporarily in the United States for the primary purpose of studying at The
University of Michigan.
3. I will receive compensation for personal 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 _____________________________ in an
amount not in excess of $9,000 for any taxable year. I have not previously claimed an
income tax exemption under this treaty for income received as a teacher, researcher, or
student before the date of my arrival in the United States.
4. I will be present in the United States only for such period of time as may be reasonably
or customarily required to effectuate the purpose of this visit.
5. 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 taxable years,