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Wisconsin Form Eic-A - Earned Income Credit - Information For Up To Three Qualifying Children - 2003

2003 Wisconsin Form EIC-A

Earned Income Credit

Information for up to three qualifying children

Instructions

Complete the information for each qualifying child for the Wisconsin Earned Income Credit. If you have more than three

qualifying children, you only have to list three to get the maximum credit.

Qualifying

Child 2

Child

Child 1

Child 3

Information

First

Last

First

Last

First

Last

1 Child’s name

2 Child’s

social security number

3 Child’s

Son or Daughter

relationship to you

Grandchild

(check one)

Foster Child

Other

(explain relationship)

4 Number of months child

lived with you in 2003

NOTE: If the child lived with you

for more than half of 2003, but less

than 7 months, enter “7”. If the

child was born or died in 2003, and

your home was the child’s for the

entire time he or she was alive

during 2003, enter “12”.

5 Child’s

year of birth

6 If the child was born

before 1985 –

a Was the child under age 24

at the end of 2003 and a full

Yes

time student?

b Was the child permanently

and totally disabled during

Yes

any part of 2003?

I-012 (R. 9-03)

Wisconsin Form Eic-A - Earned Income Credit - Information For Up To Three Qualifying Children - 2003

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