2018 Compliance Doc1: EIC Validation Form

Earned Income Credit (EIC) Validation Form
TODAYS DATE*

MonthDayYear
Your Name (Tax Payer/Client)*

First NameLast Name
Spouse's Name (Tax Payer/Client)

First NameLast Name
Your email where a copy of this form will be sent to you
Your Tax Preparer's Name*
Your Tax Preparer's E-mail is Required to Have Them Receive a Copy of This Form*
Your Tax Preparer's E-mail is Required to Have Them Receive a Copy of This Form*
taxpreparer@ffstaxes.com
Please Click on the Acknowledgments & Sign If You Agree*

I acknowledge that the information I provided to my tax preparer about my dependent(s) for my tax return, is true and accurate.I have verified my dependent(s) information that has been entered into my tax return in reference to the Earned Income Credit (EIC) that resulted in the info I provided.
If the IRS looks at your tax return, what documents will you be able to provide to establish the dependent(s) lived with you for the month's you stated on your return? (check all that apply)*

School RecordsLandlord StatementHealth Care Provider StatementMedical RecordsPlacement Agency StatementsSocial Service RecordsPlace of WorshipIndian Tribal Official StatementEmployer StatementOther-Specify below
Other: Please Specify
Client Signature Acknowledgement (sign with your mouse)*

Clear
Spouse's Signature Acknowledgement (if applicable)*

Clear
Client Signature Acknowledgement (sign with your mouse)*
Spouse's Signature Acknowledgement (if applicable)
Last 4 digits of your social security number*
Should be Empty:

Earned Income Credit (EIC) Validation Form