Form Eic - A - Earned Income Credit - Additional Information For 3rd Qualifying Child - 2002

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2002 Wisconsin Form EIC – A
rd
Earned Income Credit – Additional Information for 3
Qualifying Child
Instructions
If claiming 3 or more children for Wisconsin Earned Income Credit, complete the following information about
the third (3rd) qualifying child.
110
100
1. Child’s Name _____________________
_________________________
First Name
Last Name
120
2. Child’s Social Security Number _ _ _ - _ _ - _ _ _ _
3. Child’s relationship to you
Choose one:
_ Son or Daughter
_ Grandchild
130
_ Foster Child
140
_ Other ______________________(Explain how related)
150
4. Number of months the child lived with you in 2002 _ _
Note: If the child lived with you for more than half of 2002, but less than 7 months, enter "7". If the child was born or died in
2002 and your home was the child's for the entire time he or she was alive during 2002, enter "12.
160
5. Child’s Year of Birth _ _ _ _
If the third qualifying child was more than 18 years old on December 31, 2002, answer the following
6.
questions.
170
a.
Was the child a full time student at the end of 2002? _ Yes
_ No
180
b.
Was the child permanently disabled at the end of 2002?
_ Yes
_ No

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