Form 1npr Draft - Nonresident & Part-Year Resident Wisconsin Income Tax - 2012 Page 17
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18400-00-5483
Mary N. Sorrel
SINGLE PARENT
600-00-1002
2
Form 8867 (2011)
Page
Part II
Taxpayers With a Child
Child 1
Child 2
Child 3
Caution. If there is more that one child , complete lines 8 through 14 for one
child before going to the next column.
LIVEWITH
Sunny Sorrel
PARENT
8
Child's name
9
Is the child the taxpayer's son, daughter, stepchild, foster child, brother, sister,
X
stepbrother, stepsister, half brother, half sister, or a descendant of any of them?
Yes
No
Yes
No
Yes
No
10
Is either of the following true?
The child is unmarried, or
The child is married, can be claimed as the taxpayer's dependent, and
X
is not filing a joint return (or is filing it only as a claim for refund).
Yes
No
Yes
No
Yes
No
11
Did the child live with the taxpayer in the United States for over half of the
X
year? See the instructions before answering
Yes
No
Yes
No
Yes
No
12
Was the child (at the end of 2011) -
Under age 19 and younger than the taxpayer (or the taxpayer's spouse,
if the taxpayer files jointly),
Under age 24, a full- time student, and younger than the taxpayer (or the
taxpayer's spouse, if the taxpayer files jointly), or
X
Any age and permanently and totally disabled?
Yes
No
Yes
No
Yes
No
If you checked "Yes" on lines 9, 10, 11, and 12, the child is the
taxpayer's qualifying child; go to line 13a. If you checked "No" on line
9, 10, 11, or 12, the child is not the taxpayer's qualifying child; see the
instructions for line 12 on page 4.
X
Yes
No
Yes
No
Yes
No
13 a
Could any other person check "Yes" on lines 9, 10, 11, and 12 for the child?
If you checked "No" on line 13a, go to line 14. Otherwise, go to
line 13b.
Enter the child's relationship to the other person(s)
b
c
Under the tiebreaker rules, is the child treated as the taxpayer's qualifying
Yes
No
Yes
No
Yes
No
child? See the instructions before answering
Don't know
Don't know
Don't know
If you checked "Yes" on line 13c, go to line 14. If you checked
"No," the taxpayer cannot take the EIC based on this child and cannot
take the EIC for taxpayers who do not have a qualifying child. If there
is more than one child, see the Note at the bottom of this page. If you
checked "Don't know," explain to the taxpayer that, under the
tiebreaker rules, the taxpayer's EIC and other tax benefits may be
disallowed. Then, if the taxpayer wants to take the EIC based on this
child, complete lines 14 and 15. If not, and there are no other qualifying
children, the taxpayer cannot take the EIC, including the EIC for
taxpayers without a qualifying child; do not complete Part III. If there
is more than one child, see the Note at the bottom of this page.
14
Does the qualifying child have an SSN that allows him or her to work or is
X
valid for EIC purposes? See the instructions before answering
Yes
No
Yes
No
Yes
No
If you checked "No" on line 14, the taxpayer cannot take the EIC
based on this child and cannot take the EIC for taxpayers who do not
have a qualifying child. If there is more than one child, see the Note at
the bottom of this page. If you checked "Yes" on line 14, continue.
15
Are the taxpayer's earned income and adjusted gross income each less
X
than the limit that applies to the taxpayer for 2011? See Pub.
Yes
No
596 for the limit
If you checked "No" on line 15, stop; the taxpayer cannot take the
EIC. If you checked "Yes" on line 15, the taxpayer can take the EIC.
Complete Schedule EIC and attach it to the taxpayer's return. If there
are two or three qualifying children with valid SSNs, list them on
Schedule EIC in the same order as they are listed here. If the taxpayer's
EIC was reduced or disallowed for a year after 1996, see Pub. 596 to
see if Form 8862 must be filed. Go to line 20.
Note. If you checked "No" on line 13c or 14 but there is more than one
child, complete lines 8 through 14 for the other child(ren) (but for no more
than three qualifying children). Also do this if you checked "Don't know" on
line 13c and the taxpayer is not taking the EIC based on this child.
Form 8867 (2011)
8867 (2011)
FD8867- 2V 1.21
Form Sof t w are Copyrigh t 1996 - 2013 H RB Tax Group, Inc.
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