Form 1npr Draft - Nonresident & Part-Year Resident Wisconsin Income Tax - 2012 Page 18
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18400-00-5483
Mary N. Sorrel
SINGLE PARENT
600-00-1002
3
Form 8867 (2011)
Page
Part III
Taxpayers Without a Qualifying Child
16
Was the taxpayer's main home, and the main home of the taxpayer's spouse if filing jointly, in the United States
for more than half the year? (Military personnel on extended active duty outside the United States are considered
to be living in the United States during that duty period. See Pub. 596.)
Yes
No
If you checked "No" on line 16, stop; the taxpayer cannot take the EIC. Otherwise, continue.
17
Was the taxpayer, or the taxpayer's spouse if filing jointly, at least age 25 but under age 65 at the end
of 2011?
Yes
No
If you checked "No" on line 17, stop; the taxpayer cannot take the EIC. Otherwise, continue.
18
Is the taxpayer, or the taxpayer's spouse if filing jointly, eligible to be claimed as a dependent on anyone
else's federal income tax return for 2011? If the taxpayer's filing status is married filing jointly, check "No"
Yes
No
If you checked "Yes" on line 18, stop; the taxpayer cannot take the EIC. Otherwise, continue.
19
Are the taxpayer's earned income and adjusted gross income each less than the limit that applies
to the taxpayer for 2011? See Pub. 596 for the limit
Yes
No
If you checked "No" on line 19, stop; the taxpayer cannot take the EIC. If you checked "Yes"
on line 19, the taxpayer can take the EIC. If the taxpayer's EIC was reduced or disallowed for
a year after 1996, see Pub. 596 to find out if Form 8862 must be filed. Go to line 20.
Due Diligence Requirements
Part IV
20
Did you complete Form 8867 based on current information provided by the taxpayer or reasonably
X
obtained by you?
Yes
No
21
Did you complete the EIC worksheet found in the Form 1040, 1040A, or 1040EZ instructions (or your
X
own worksheet that provides the same information as the 1040, 1040A, or 1040EZ worksheet)?
Yes
No
22
Did you comply with knowledge requirements? (To comply with the knowledge requirements, you
must not know or have reason to know that any information used to determine the taxpayer's eligibility
for, and the amount of, the EIC is incorrect. You may not ignore the implications of information furnished
to or known by you, and you must make reasonable inquires if the information furnished appears to be
incorrect, inconsistent, or incomplete. At the time you make these inquires, you must document in your
files the inquires you made and the responses you received.)
X
Yes
No
23
Did you keep the following records?
Form 8867,
The EIC worksheet(s) or your own worksheet(s),
A record of how, when, and from whom the information used to prepare the form and worksheet(s)
was obtained, and
X
Copies of any documents provided by the taxpayer and on which you relied to complete the form and the worksheet
Yes
No
If you checked "Yes" on lines 20, 21, 22, and 23, submit Form 8867 in the manner required, and keep the
records described on line 23 for 3 years (see instructions), you have complied with all the due diligence
requirements.
If you checked "No" on lines 20, 21, 22, or 23, you have not complied with all the due diligence requirements
and may have to pay a $500 penalty for each failure to comply.
Form 8867 (2011)
8867 (2011)
FD8867- 3V 1.21
Form Sof t w are Copyrigh t 1996 - 2013 H RB Tax Group, Inc.
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