Form W-5 Earned Income Credit Advance Payment Certificate 2010

Summary: This is an example of the lower portion of Form W-5 (2007). The line items to be completed are:

Print or type your full name field
Your social security number field
1. I expect to have a qualifying child and be able to claim the earned income credit for 2007 using that child. I do not have another Form W-5 in effect with any other current employer, and I choose to get advance E.I.C. payments
- Yes checkbox
- No checkbox
2. Check the box that shows your expected filing status for 2007:
- Single, head of household, or qualifying widow(er) checkbox
- Married filing jointly checkbox
3. If you are married, does your spouse have a Form W-5 in effect for 2007 with any employer?
- Yes checkbox
- No checkbox
Under penalties of perjury, I declare that the information I have furnished above is, to the best of my knowledge, true, correct, and complete.
- Signature field
- Date field