Form It-40 - Indiana Full-Year Resident Individual Income Tax Return - 2000 Page 4
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5Schedule IN-EIC
Attachment
Schedule IN-EIC: Indiana’s Earned Income Credit
Form IT-40/IT-40PNR
Sequence No. 05
Attach only if claiming this credit
Rev. 8/00 SF# 49469
A
Enter your first name, middle initial and last name and spouses full name if filing a joint return
Your Social
Security Number
Section A: Figure your Total Federal Income
Enter the amount from your 2000 federal Form 1040 line 22,
Form 1040A line 15 or Form 1040EZ line 4 (if less than zero, enter zero) .......................................................
A1 $ ____________
F Yes, Continue to Section B.
F No, STOP. You do not get this credit.
Is the line A1 amount less than $12,000?
Section B: Qualifying Child (Read the instructions in the booklet to explain the terms used below)
3
2
4
1
First
First
First
First
Enter each Child’s Name here
Last
Last
Last
Last
(Please print clearly or type)
Check only one box in each section for each child listed.
H
H
H
H
a
a
a
a
Your child
H
H
H
H
b
b
b
b
Adopted child
H
H
H
H
c
c
c
c
Grandchild
B-1
H
H
H
H
d
d
d
d
Stepchild
H
H
H
H
e
e
e
e
Foster child, (not related)
H
H
H
H
f
f
f
f
Foster child, (related)
H
H
H
H
g
g
g
g
Under age 18
H
H
H
H
h
h
h
Age 18
h
B-2
H
H
H
H
i
i
i
Age 19 - 24 and a full-time student
i
H
H
H
H
j
j
j
Age 19 or older and totally disabled
j
Child lived with you at least 1/2 of the
H
H
H
H
k
k
k
k
year (If not, see below)
(if foster child,
B-3
must have lived with you entire year)
H
H
H
H
l
l
l
l
Child was born or died in 2000,
and lived with you while alive in 2000.
You must have a qualifying child to continue to Section C. A child qualifies only if a box is checked in Sections B-1, B-2 and B-3.
If you do not have a qualifying child, STOP. You do not get this credit.
(Attach a separate sheet of paper to list additional children.)
Section C: Figure your Earned Income
Before you begin:
If you were a household employee and received a W-2 for less than $1,100 in 2000 or were a minister or
member of a religious order, see Special Rules in the booklet or on the back of this schedule before
completing this section. Also see Special Rules if federal Form 1040 line 7 includes workfare payments or
any amount paid to an inmate in a penal institution.
Enter your (and spouses if filing joint) wages, salary, tips and other compensation from federal Form 1040
or 1040A line 7, or Form 1040EZ line 1 ............................................................................................................. C1 $ _____________
Enter any nontaxable earned income (e.g. from box 13 of your W-2 form; see instructions in the booklet) ..... C2 $ _____________
If you were self-employed, complete the worksheet on the back and enter the amount from line 4 ................. C3 $ _____________
Add lines C1, C2 and C3 and enter here (if this is a loss, STOP. You do not get this credit) ........................... C4 $ _____________
Enter amount from Section A line A1 above $ _______________ Multiply by 80% (.80) and enter here ....... C5 $ _____________
Is the amount on line C4 equal to or greater than the amount on line C5?
F No, STOP. You do not get this credit. F Yes, Continue to Section D on the back to figure your credit.
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