Form W-5 Earned Income Credit Advance Payment Certificate 2005. Summary: This is an example of the lower portion of Form W-5 (2005). The line items to be completed are:
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“Print or type your full name” field
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“Your social security number” field
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“1. I expect to have a qualifying child and be able to claim the earned income credit for 2005. 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”
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“Yes” checkbox
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“No” checkbox
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“2. Check the box that shows your expected filing status for 2005:”
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“Single, head of household, or qualifying widow(er)” checkbox
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“Married filing jointly” checkbox
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“3. If you are married, does your spouse have a Form W-5 in effect for 2005 with any employer?”
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“Yes” checkbox
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“No” checkbox
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“Under penalties of perjury, I declare that the information I have furnished above is, to the best of my knowledge, true, correct,
and
complete.”
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“Signature” field
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“Date” field
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