Form 1npr Draft - Nonresident & Part-Year Resident Wisconsin Income Tax - 2012 Page 13
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18Earned Income Credit
OMB No. 1545- 0074
SCHEDULE EIC
(Form 1040A or 1040)
Qualifying Child Information
Complete and attach to Form 1040A or 1040 only if you have a qualifying child.
Attachment
D epart ment of t h e Treasury
43
Int ernal Revenue Service (99)
Information about Schedule EIC (Form 1040A or 1040) and its instructions is at
Sequence No.
Name(s) shown on return
Your social security number
Mary N. Sorrel
400-00-5483
SINGLE PARENT
600-00-1002
See the instructions for Form 1040A, lines 38a and 38b, or Form 1040, lines 64a and 64b, to make
Before you begin:
sure that (a) you can take the EIC, and (b) you have a qualifying child.
Be sure the child's name on line 1 and social security number (SSN) on line 2 agree with the child's social security card.
Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child's
social security card is not correct, call the Social Security Administration at 1- 800- 772- 1213.
If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See separate
instructions for details.
It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.
Child 1
Child 2
Child 3
Qualifying Child Information
First name
Last name
First name
Last name
First name
Last name
1
Child's name
If you have more than three
qualifying children, you only
have to list three to get the
LIVEWITH
maximum credit.
Sunny
Sorrel
PARENT
2
Child's SSN
The child must have an SSN as
defined in the instructions for
Form 1040A, lines 38a and 38b,
or Form 1040, lines 64a and 64b,
unless the child was born and
died in 2012. If your child was
born and died in 2012 and did
not have an SSN, enter "Died"
on this line and attach a copy of
the child's birth certificate, death
400-00-5443
600-00-1012
certificate, or hospital medical
records.
3
Child's year of birth
2003
2003
Year
Year
Year
If born after 1993 and the child was
If born after 1993 and the child was
If born after 1993 and the child was
younger than you (or your spouse,
younger than you (or your spouse,
younger than you (or your spouse,
if filing jointly), skip lines 4a and 4b;
if filing jointly), skip lines 4a and 4b;
if filing jointly), skip lines 4a and 4b;
go to line 5.
go to line 5.
go to line 5.
4
a
Was the child under age 24 at
✔
Yes.
No.
Yes.
No.
Yes.
No.
the end of 2012, a student,
and younger than you (or
Go to
Go to line 4b.
Go to
Go to line 4b.
Go to
Go to line 4b.
your spouse, if filing jointly)?
line 5.
line 5.
line 5.
b
Was the child permanently and
Yes.
No.
Yes.
No.
Yes.
No.
totally disabled during any part
of 2012?
Go to
The child is not a
Go to
The child is not a
Go to
The child is not a
line 5.
qualifying child.
line 5.
qualifying child.
line 5.
qualifying child.
5 Child's relationship
to you
(for example, son, daughter,
SON
grandchild, niece, nephew,
daughter
foster child, etc.)
6
Number of months child
lived with you in the
United States during
2012
If the child lived with you for
more than half of 2012 but less
than 7 months, enter "7."
11
12
months
months
months
If the child was born or died in
2012 and your home was the
Do not enter more than 12
Do not enter more than 12
Do not enter more than 12
child's home for more than half the
months.
months.
months.
time he or she was alive during
2012, enter "12."
KBA
For Paperwork Reduction Act Notice, see your tax return instructions.
Schedule EIC (Form 1040A or 1040) 2012
1040- Sch EIC (2012)
FDEIC- 1 (DRAFT FORM)
Form Sof t w are Copyrigh t 1996 - 2013 H RB Tax Group, Inc. 1.31- 15.2
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