Form It-40/it-40pnr - Schedule In-Eic - Indiana'S Earned Income Credit - 2012

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Schedule IN-EIC: Indiana’s Earned Income Credit
Schedule IN-EIC
Enclosure
Form IT-40/IT-40PNR
Sequence No. 9
2012
You must enclose if claiming this credit on Forms IT-40 or IT-40PNR
State Form 49469
(R12 / 9-12)
Name(s) shown on Form IT-40/IT-40PNR
Your Social Security Number
Section A: Figure Your Indiana Earned Income Credit
A-1 Enter the earned income credit from your federal income tax return Form 1040 line 64a,
.00
A-1
Form 1040A line 38a, or Form 1040EZ line 8a _______________________________________
.00
A-2 Enter your earned income (see instructions) _________________________________________
A-2
A-3 Enter your Indiana earned income credit (see instructions).
Carry this total to Form IT-40, Schedule 5, line 5, or
.00
Form IT-40PNR, Schedule F, line 5, Box A _________________ Indiana Earned Income Credit
A-3
Section B: Complete if you claimed one or more children on your federal Schedule EIC. See instructions.
Child 1
Child 2
Enter each child’s information
First name
First name
Last name
Last name
Child’s Social Security Number(s)
Enter letter (e.g. A, B, C, etc.) in boxes below that describes each child’s relationship, age and location to you.
Child 1
Child 2
B-1 Relationship:
A Your Child
B Grandchild
C Stepchild
D Foster Child (not related)
E Other (related foster child, or other
related child - see instructions)
B-2 Age:
A Under age 18
B Age 18
C Age 19 - 24 and full-time student
D Age 19 or older and totally
disabled
B-3 Location:
A Child lived with you at
least ½ of the year
B Child was born or died
in 2012, and lived with
you while alive in 2012.
Important: You must complete and attach this schedule to your Form IT-40 or IT-40PNR when claiming the earned income credit.
*17212111694*
17212111694

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