Form 8867 - Paid Preparer'S Earned Income Credit Checklist - 2014 Page 4
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Form 8867 (2014)
Page
Part V
Documents Provided to You
26
Identify below any document that the taxpayer provided to you and that you relied on to determine the taxpayer's EIC
Check all that apply. Keep a copy of any documents you relied on. See the instructions before answering. If there
eligibility.
is no qualifying child, check box a. If there is no disabled child, check box o.
Residency of Qualifying Child(ren)
i
a No qualifying child
Place of worship statement
b School records or statement
j
Indian tribal official statement
c Landlord or property management statement
k Employer statement
d Health care provider statement
l
Other (specify)
e Medical records
f Child care provider records
g Placement agency statement
h Social service records or statement
m Did not rely on any documents, but made notes in file
n Did not rely on any documents
Disability of Qualifying Child(ren)
o No disabled child
s Other (specify)
p Doctor statement
q Other health care provider statement
r Social services agency or program statement
t Did not rely on any documents, but made notes in file
u Did not rely on any documents
27
If a Schedule C is included with this return, identify below the information that the taxpayer provided to you and that you relied
on to prepare the Schedule C. Check all that apply. Keep a copy of any documents you relied on. See the instructions
before answering. If there is no Schedule C, check box a.
Documents or Other Information
a No Schedule C
h Bank statements
b Business license
i
Reconstruction of income and expenses
c Forms 1099
j
Other (specify)
d Records of gross receipts provided by taxpayer
e Taxpayer summary of income
f Records of expenses provided by taxpayer
k Did not rely on any documents, but made notes in file
g Taxpayer summary of expenses
l
Did not rely on any documents
8867
Form
(2014)
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