Form 1npr Draft - Nonresident & Part-Year Resident Wisconsin Income Tax - 2012 Page 16
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18OMB No. 1545- 1629
8867
Paid Preparer's Earned Income Credit Checklist
Form
For more information about Form 8867, see
D epart ment of t h e Treasury
At t ach ment
To be completed by preparer and filed with Form 1040, 1040A, or 1040EZ.
177
Int ernal Revenue Service
Seq uence No.
Taxpayer name(s) shown on return
Taxpayer's social security number
Mary N. Sorrel
SINGLE PARENT
400-00-5483
600-00-1002
For the definitions of the following terms, see Pub. 596.
Investment Income
Qualifying Child
Earned Income
Full- time Student
Part I All Taxpayers
MICHELE TAXPRO
P13333333
1
Enter preparer's name and PTIN
X
2
Is the taxpayer's filing status married filing separately?
Yes
No
If you checked "Yes" on line 2, stop; the taxpayer cannot take the EIC. Otherwise, continue.
3
Does the taxpayer (and the taxpayer's spouse if filing jointly) have a social security number (SSN)
X
that allows him or her to work or is valid for EIC purposes? See the instructions before answering
Yes
No
If you checked "No" on line 3, stop; the taxpayer cannot take the EIC. Otherwise, continue.
X
4
Is the taxpayer filing Form 2555 or Form 2555- EZ (relating to the exclusion of foreign earned income)?
Yes
No
If you checked "Yes" on line 4, stop; the taxpayer cannot take the EIC. Otherwise, continue.
X
5a
Was the taxpayer a nonresident alien for any part of 2011?
Yes
No
If you checked "Yes" on line 5a, go to line 5b. Otherwise, skip line 5b and go to line 6.
b
Is the taxpayer's filing status married filing jointly?
Yes
No
If you checked "Yes" on line 5a and "No" on line 5b, stop; the taxpayer cannot take the EIC.
Otherwise, continue.
6
Is the taxpayer's investment income more than $3,150? See Rule 6 in Pub. 596 before answering
X
Yes
No
If you checked "Yes" on line 6, stop; the taxpayer cannot take the EIC. Otherwise, continue.
7
Could the taxpayer, or the taxpayer's spouse if filing jointly, be a qualifying child of another person for 2011?
If the taxpayer's filing status is married filing jointly, check "No". Otherwise, see Rule 10 (Rule 13 if the taxpayer
X
does not have a qualifying child) in Pub. 596 before answering
Yes
No
If you checked "Yes" on line 7, stop; the taxpayer cannot take the EIC. Otherwise,
go to Part II or Part III, whichever applies.
KBA For Paperwork Reduction Act Notice, see page 4.
Form 8867 (2011)
Information provided by: SINGLE PARENT
Mary N. Sorrel
Information provided in person.
Date information provided: 09/12/2012
8867 (2011)
FD8867- 1V 1.21
Form Sof t w are Copyrigh t 1996 - 2013 H RB Tax Group, Inc.
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