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

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. If own child). the qualifying child was born and died in 2003 and did not Draft ashave an SSN, attachof that child’s birth certificate to Form When To File 8856. You will have to file this form only once for each qualifying For purposes of taking the EIC, a valid SSN is a number child, regardless of the number of years that you will claim issued by the Social Security Administration unless “Not the EIC for that child. Valid for Employment” is printed on the social security card There are two different time periods for filing Form 8856. and the number was issued solely to apply for or receive a You may file Form 8856 either: Federally funded benefit. ● Before January 1, 2004. If you file the form during this Part II period, you may be able3 to avoid/ a delay28 in the issuance/2003 of your tax refund for 2003. If you are required to send a birth or marriage ● With your 2003 tax return. Under this option, your refund certificate do not send the original; send only a will be delayed while we review the information you copy. submitted. Note. If there is no certificate of marriage because the Where To File couple was living together in a common law marriage, call Send the form to: 1-800-XXX-XXXX for the documentation you need to provide. Internal Revenue Service Step 1. Check the box in column (a) that describes the Stop 4300, Annex R2 qualifying child’s relationship to you. Check only one box. If Kansas City, MO 64999 the relationship is not listed on Form 8856, call Note. If you file this form after December 31, 2003, you may 1-800-XXX-XXXX. either file it at the above address or attach it to your tax Step 2. The information you must provide depends on the return. If you file it with your return, be sure to send it to the qualifying child’s relationship to you. Internal Revenue Service address shown in the instructions Example 1. The qualifying child is your grandson, Johnny. for your tax return. His parents are your daughter, Millie, and Millie’s husband, Harold. You may either check the box in column (b) and You cannot file this form electronically. However, attach a copy of Millie’s birth certificate, or you may enter you may still file your tax return electronically. If Millie’s name and social security number in column (c). you do so, send Form 8856 and all required attachments to: Example 2. You married Maude who had a daughter, Mary, from a previous marriage. Maude died and you are now Internal Revenue Service caring for Mary. You have checked the "stepchild" box in Stop 4300, Annex R2 column (a). Check the box in column (d) and attach a copy Kansas City, MO 64999 of your marriage certificate to Maude. 3 I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING INSTRUCTIONS TO PRINTERS FORM 8856, PAGE 4 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 4 Example 3. You are caring for your brother Bob’s You are not required to provide the information requested grandson, Timmy. Timmy’s mother is Bob’s daughter, Julie. on a form that is subject to the Paperwork Reduction Act Bob is in a nursing home and Julie abandoned Timmy. You unless the form displays a valid OMB control number. Books have checked the box for grandniece or grandnephew in or records relating to a form or its instructions must be column (a). You must do one of the following to verify retained as long as their contents may become material in Timmy’s relationship to you: the administration of any Internal Revenue law. Generally, tax ● Check both boxes in column (b) and attach copies of the returns and return information are confidential, as stated in birth certificates for Bob and Julie. Code section 6103. ● Enter Bob and Julie’s names and social security numbers We ask for tax return information to carry out the tax laws on the appropriate lines in column (c). of the United States. We need it to figure and collect the ● Check the first box in column (b), attach a copy of Bob’s right amount of tax. birth certificate, and enter Julie’s name and social security We may give the information to the Department of Justice number on the next line in column (c). and to other Federal agencies, as provided by law. We may ● Enter Bob’s name and social security number on the first give it to cities, states, the District of Columbia, and U.S. line in column (c), check the second box in column (b) and commonwealths or possessions to carry out their tax laws. attach a copy of Julie’s birth certificate. We may also disclose this information to other countries under a tax treaty, or to Federal and state agencies to Part III enforce Federal nontax criminal laws and to combat terrorism. You must sign and date Part III at the bottom of page 2 under penalties of perjury before you send this form to us If you do not file a return, do not give the information with any required documents. Criminal penalties may be asked for, or give fraudulent information, you may be imposed for making a false statement. charged penalties and be subject to criminal prosecution. Please keep this notice with your records. It may help you Privacy Act and Paperwork Reduction Act Notice. The if we ask you for other information. If you have any questions Privacy Act of 1974 and the Paperwork Reduction Act of about the rules for filing and giving information, please call or 1980 require that when we ask you for information we must visit any Internal Revenue Service office. first tell you our legal right to ask for the information, why we The time needed to complete and file this form will vary are asking for it, and how it will be used. We must also tell depending on individual circumstances. The estimated you what could happen if we do not receive it and whether average time is: Recordkeeping, 6 min.; Learning about the your response is voluntary, required to obtain a benefit, or law, 13 min.; Preparing the form, 13 min.; Copying, mandatory under the law. assembling, and sending the form to the IRS, 20 min. This notice applies to all papers you file with us. It also If you have comments concerning the accuracy of these applies to any questions we need to ask you so we can time estimates or suggestions for making this form simpler, complete, correct, or process your return; figure your tax; we would be happy to hear from you. You can write to the and collect tax, interest, or penalties. Tax Forms Committee, Western Area Distribution Center, Draft asRancho Cordova, of CA 95743-0001. Do not send the form to Our legal right to ask for information is Internal Revenue Code sections 6001, 6011, and 6012(a), and their this address. Instead, see Where To File on page 3. regulations. They say that you must file a return or statement with us for any tax for which you are liable. Your response is mandatory under these sections. Code section 6109 and its regulations say that you must provide your taxpayer identification number on what you file. This is so we know who you are, and can process3 your/ return28 and other papers./2003 Printed on recycled paper