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Qualifying Child Relationship Statement 2003 Department of the Treasury See Instructions on Page 3

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4 TLS, have you I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING transmitted all R Action Date Signature text files for this INSTRUCTIONS TO PRINTERS FORM 8856, PAGE 1 OF 4 cycle update? 1 MARGINS; TOP 13mm ( ⁄2"), CENTER SIDES. PRINTS: HEAD TO HEAD O.K. to print PAPER: WHITE WRITING, SUB. 20. INK: BLACK 1 FLAT SIZE: 216mm (8 ⁄2") x 279mm (11") Date PERFORATE: None Revised proofs DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT requested OMB No. 1545-1830 Form 8856 Qualifying Child Relationship Statement ᮣ 2003 Department of the Treasury See instructions on page 3. Attachment Internal Revenue Service Sequence No. 135 Before you begin: If the qualifying child is your son, daughter, adopted child, brother, or sister (and not a foster child or a child pending adoption), do not complete this statement. The IRS will contact you only if it is unable to verify the relationship. Your first name and initial Last name Your social security number If you will be filing a joint return, spouse’s first name and Last name Spouse’s social security number initial Home address (number and street). If you have a P.O. box, see instructions Your daytime phone number () City, town or post office, state, and ZIP code Your evening phone number () Part I Qualifying Child Information. If you have two qualifying children, complete a separate form for each child. Child’s first name Last name Child’s social security number Part II Proof of Relationship Instructions for columns (b) and (c) below. For each person described in column (a) Check only (b) next to the box you checked in column (a), do only one of the following: one box below ● Attach a copy of that person’s birth certificate and check the box in column (b) (d) Check the box to that describes or 3 show you are attaching the qualifying ● the required document child’s Enter that person’s name and social security number in column (c). described below relationship to (b) Check box(es) to show (c) Name and social security number of the person described you you are attaching a copy of in column (b) the birth certificate for: Name (first and last) Social security number Your child who is the Grandchild parent Draftof the qualifying child as of Your child who is the grandparent of the qualifying child Great- grandchild Your grandchild who is the parent of the qualifying child / /200 A copy of your 3 28 certificate of marriage to Stepchild the parent of the qualifying child Your stepchild who is the A copy of your Step parent of the qualifying child certificate of marriage to grandchild the grandparent of the qualifying child Your stepchild who is the grandparent of the qualifying child A copy of your Step great- certificate of marriage to grandchild Your step grandchild the great grandparent of who is the parent of the the qualifying child qualifying child A copy of the certificate of marriage Stepbrother between your parent or stepsister and the qualifying child’s parent For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 4. Cat. No. 24607L Form 8856 (2003) (continued on page 2) 4 I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING INSTRUCTIONS TO PRINTERS FORM 8856, PAGE 2 OF 4 1 MARGINS; TOP 13mm ( ⁄2"), CENTER SIDES. PRINTS: HEAD TO HEAD PAPER: WHITE WRITING, SUB. 20. INK: BLACK 1 FLAT SIZE: 216mm (8 ⁄2") x 279mm (11") PERFORATE: None DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT Form 8856 (2003) Page 2 Part II Proof of Relationship (continued) Instructions for columns (b) and (c) below. For each person described in column (a) Check only (b) next to the box you checked in column (a), do only one of the following: one box below ● Attach a copy of that person’s birth certificate and check the box in column (b) (d) Check the box to that describes or show you are attaching the qualifying ● the required document child’s Enter that person’s name and social security number in column (c). described below relationship to (b) Check box(es) to show (c) Name and social security number of the person described you you are attaching a copy of in column (b) the birth certificate for: Name (first and last) Social security number Your brother or sister Niece or who is the parent of the nephew qualifying child Step niece or Your stepbrother or A copy of the certificate of step nephew stepsister who is the parent marriage between your parent and of the qualifying child the qualifying child’s grandparent Your brother or sister who is the grandparent of the Grandniece qualifying child or grandnephew Your niece or nephew who is the parent of the qualifying child Your stepbrother or stepsister who is the grandparent Step of the qualifying child A copy of the certificate grandniece of marriage between your or step Your step niece or step parent and the qualifying child’s great-grandparent grandnephew nephew who is the parent of the qualifying child Your brother or sister who is the great-grandparent of the qualifying child Great- YourDraft niece or nephew as of grandniece who is the grandparent of the or great- qualifying child grandnephew Your grandniece or grandnephew who is the parent of the qualifying child Your stepbrother or stepsister who is the great- grandparent/ of the /200 qualifying3 child 28 3 Step great- Your step niece or step A copy of the certificate of grandniece nephew who is the grandparent marriage between your parent or step great- of the qualifying child and the qualifying child’s great- grandnephew great-grandparent Your step grandniece or step grandnephew who is the parent of the qualifying child The letter from an Child pending authorized placement agency adoption verifying that the child has been placed with you for adoption. The letter from an Foster child authorized placement agency verifying that the child has been placed with you as a foster child Part III Signature Under penalties of perjury, I declare that I have examined this statement, and to the best of my knowledge and belief, it is true, correct, and complete. Your signature ᮣ Date ᮣ Spouse’s signature (If you will be filing a joint return) ᮣ Date ᮣ Form 8856 (2003) 4 I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING INSTRUCTIONS TO PRINTERS FORM 8856, PAGE 3 OF 4 1 MARGINS; TOP 13mm ( ⁄2"), CENTER SIDES. PRINTS: HEAD TO HEAD PAPER: WHITE WRITING, SUB. 20. INK: BLACK 1 FLAT SIZE: 216mm (8 ⁄2") x 279mm (11") PERFORATE: None DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT Form 8856 (2003) Page 3 Instructions Address and Phone Numbers P.O. box. Enter your box number only if your Post Office Purpose of Form does not deliver mail to your home. Otherwise, enter your Use Form 8856 if you have a qualifying child for the earned home street address. income credit (EIC) to show the child meets the relationship Daytime and evening phone numbers. Providing your test (defined below) starting with calendar year 2003, unless daytime and evening phone numbers may help speed the the child is your son, daughter, adopted child, brother, or processing of this form. We may have questions about the sister. information you provided. By answering our questions over For more information on the EIC eligibility rules, including the phone, we may be able to continue processing the form the definition of qualifying child, see Pub. 596, Earned without mailing you a letter. If you will be filing a joint return, Income Credit (EIC). You can order Pub. 596 by calling you may enter either spouse’s phone numbers. 1-800-TAX-FORM (1-800-829-3676) or you can download it from the IRS website at www.irs.gov. What We Will Do After We Receive This Pre-recorded information about the EIC is also available by Form phone 24 hours a day, 7 days a week. Call 1-800-829-4477 We will review the information you send us and let you know and select TeleTax Topic No. 601. Have paper and a pen or if you have met the relationship test needed to get your EIC. pencil handy to take notes. If we need more information, we will contact you. You may also have to file Form 8836, Qualifying How To Get Help Child Residency Statement, to certify your child Call 1-800-XXX-XXXX if you need assistance completing this meets the residency test. See Form 8836 for more form. You may also visit any IRS Taxpayer Assistance Center. details. Part I Relationship Test Be sure that the child you are naming is your qualifying child To meet the relationship test your child must be: and you expect to claim him or her for the EIC on your 2003 ● Your son, daughter, adopted child, stepchild, or a tax return. descendant of any of them (for example, your grandchild), You will need to complete one Form 8856 for each ● Your brother, sister, adopted brother or sister, stepbrother, qualifying child you expect to claim for EIC on your 2003 tax stepsister, or a descendant of any of them (for example, your return. Do not provide information for more than two niece or nephew), whom you cared for as you would your qualifying children. You need to provide information for only own child, or two qualifying children to claim the maximum EIC. ● A foster child (any child placed with you by an authorized Your qualifying child must have a valid social security placement agency whom you cared for as you would your number (SSN), unless the child was born and died in 2003.
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