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Form W-5 Earned Income Credit Advance Payment Certificate 2006. Summary: This is an example of the lower portion of Form W-5 (2006). 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 2006 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 2006:
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 2006 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