I was a resident of 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.

I have accepted an invitation by Michigan State University to come to the United States solely for the purpose of teaching or engaging in research at that educational institution. I will receive compensation for my teaching or research activities.

The teaching or research compensation received during the entire tax year (or during the period ) qualifies for exemption from withholding of federal tax under the tax treaty between the United States and Indonesia. I have not previously claimed an income tax exemption under that treaty for income received as a teacher or researcher before the date specified in the next paragraph.

I (insert the date of your arrival into the United States before beginning the teaching or research services for which exemption is claimed). The treaty exemption is available only for compensation paid during a period of two years beginning on that date.

Any research that I perform will be undertaken in the public interest and not primarily for the private benefit of a specific person to persons.

Signature __________________________________________     Date _____________________

Michigan State University