Summary: ATTACHMENT TO FORM 8233
(For use by students of Netherlands who are claiming Tax Treaty exemption).
1. I was a resident of The Netherlands 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 for the primary purpose of full-time study
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 The Netherlands in an
amount not in excess of $2,000 for any tax year.
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). I am claiming this
exemption only for such period of time as is reasonably necessary to complete my
Under penalties of perjury, I declare that the above statements are true, correct, and
Soc. Sec. # Date:________________________