If more than five
dependents,
see page 20.
Earned Income Crea
Qualifying Child Information
GOVERNMENT PUBLICATIONS DEPT.
f Employee's address and ZIP code
Employer's state ID number
16 State wages, tips, etc.
18 Local wages, tips, etc.
W-2 Wage and Tax
Statement
Copy C For EMPLOYEE'S RECORDS. (See Notice to
Employee on back of Copy B).
Complete and attach to Form 1040A or 1040
only if you have a qualifying child.
See the instructions for Form 1040A, line 41, or Form 1040, line 64, to make sure that
and (b) you have a qualifying child.
Before you begin: (a) you can take
If you take the EIC even tho
to 10 years. See back of s
It will take us longer to pr
for each qualifying child
Be sure the child's nam
social security card. O
EIC. If the name or S
Administration at 1-
Qualifying Child Inform
ible, you may not be allowed to take the credit for
if you do not fill in all lines that
Withholding Certificate for
Pension or Annuity Payments
Department of the Treasury
Internal Revenue Service
Purpose. This form is for U.S. citizens, resident aliens, or their
estates who are recipients of pensions, annuities, including
commercial annuities, and certain other deferred compensation.
Use this form to tell payers the correct amount of Federal income
tax to withhold from your payment(s). You also may use this form
to choose (a) not to have any income tax withheld from the
payment (except for eligible rollover distributions or payments to
U.S. citizens delivered outside the United States or its
possessions) or (b) to have an additional amount of tax withheld.
Your options depend on whether the payment is periodic,
nonperiodic, or an eligible rollover distribution as explained on
►Attach to Form 1040.
Use Schedule D-1 to list additional t
See Instru
Short-Term Capital Gains and Losses-Assets He
(a) Description of property
(Example: 100 sh XYZ Co.)
(b) Date
acquired
(Mo.. day, yr)
(c) Date sold
(Mo.. day w
page 3. Your previous
if you do not file a For
What do I need to do?
Personal Allowances W
worksheets on page 2 to
itemized deductions, adj
pensions/more-than-one
any income tax withheld,
directly to the Form W-49
Sign this form. Form W-4
A Enter "1" for yourself if no one else can claim you as a dependent.
You are single and have only one pension; or
You are married, have only one pension, and your
spouse has no income subject to withholding; or
Your income from a second pension or a job, or your spouse's
pension or wages (or the total of all) is $1,000 or less.
Personal Allowances Worksheet (Keep for your reco
C Enter "1" for your spouse. But, you may choos
has income subiect to
Provide America's Taxpayer top quality service by helping them understand and meet their
tax responsibilities and by applying the tax law with integrity and fairness to all.
Department of the Treasury
Internal Revenue Service
Publication 1194 (2003)
Catalog Number 60047 L