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Taxpayer identification number <br /> Go to www.irs.gov/Form8867 for instructions and the latest information. <br /> To be completed by preparer and filed with Form 1040, 1040NR, 1040SS, or 1040PR. <br />Taxpayer name(s) shown on return <br />Sequence No. Internal Revenue Service AttachmentDepartment of the Treasury <br />OMB No. 1545-0074FormEarned Income Credit (EIC), American Opportunity Tax Credit (AOTC), Child Tax Credit (CTC) (including the Additional <br />Paid Preparer's Due Diligence Checklist8867 <br />70 <br />2018 <br />Enter preparer's name and PTIN <br />Due Diligence Requirements <br />this return and complete the related Parts I–V for the benefit(s), and/or HOH filing <br />status claimed (check all that apply). <br />EIC AOTC <br />ACTC/ODC <br />1 <br />2 <br />3 <br />Did you complete the return based on information for tax year 2018 provided <br />by the taxpayer or reasonably obtained by you? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Yes No <br />If credits are claimed on the return, did you complete the applicable EIC and/ <br />or CTC/ACTC/ODC worksheets found in the Form 1040, 1040SS, 1040PR, or <br />1040NR instructions, and/or the AOTC worksheet found in the Form 8863 <br />instructions, or your own worksheet(s) that provides the same information, <br />and all related forms and schedules for each credit claimed? . . . . . . . . . . . . . . . . . . . . . .NoYes <br />Did you satisfy the knowledge requirement? To meet the knowledge <br />requirement, you must do both of the following. <br />Interview the taxpayer, ask questions, and document the taxpayer’s <br />responses to determine that the taxpayer is eligible to claim the credit(s) <br />credit(s) and/or HOH filing status and the amount of any credit(s) claimed. <br />Review information to determine that the taxpayer is eligible to claim the <br />Yes No <br />Did any information provided by the taxpayer or a third party for use in4 <br />preparing the return, or information reasonably known to you, appear to be <br />incorrect, incomplete, or inconsistent? (If “Yes,” answer questions 4a and 4b. <br />If “No,” go to question 5.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />b Did you document your inquiries? (Documentation should include the <br />questions you asked, whom you asked, when you asked, the information that <br />consistent information? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Did you make reasonable inquiries to determine the correct, complete, anda <br />return.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />was provided, and the impact the information had on your preparation of the <br />List those documents, if any, that you relied on. <br />determine eligibility for the credit(s) and/or HOH filing status or to compute <br />copy of any document(s) provided by the taxpayer that you relied on to <br />retention requirement, you must keep a copy of your documentation <br />5 Did you satisfy the record retention requirement? To meet the record <br />Yes No <br />NoYes <br />NoYes <br />Yes No <br />NoYes <br />substantiate eligibility for the credit(s) and/or HOH filing status and the <br />Did you ask the taxpayer whether he/she could provide documentation to6 <br />7 <br />a previous year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />(If credits were disallowed or reduced, go to question 7a; if not, go to question 8.)Yes No <br />Did you ask the taxpayer if any of these credits were disallowed or reduced in <br />a Did you complete the required recertification Form 8862? . . . . . . . . . . . . . . . . . . . . . . . .Yes No <br />8 If the taxpayer is reporting self-employment income, did you ask questions to <br />prepare a complete and correct Form 1040, Schedule C? . . . . . . . . . . . . . . . . . . . . . . . . . .Yes No <br />For Paperwork Reduction Act Notice, see separate instructions.Form 8867 (2018) <br />DAA <br />Part I <br />amount of any credit(s) claimed on the return if his/her return is selected for <br />referenced in 4b, a copy of this Form 8867, a copy of any applicable <br />worksheet(s), a record of how, when, and from whom the information used to <br />prepare Form 8867 and any applicable worksheet(s) was obtained, and a <br />Child Tax Credit (ACTC) and Credit for Other Dependents (ODC)), and Head of Household (HOH) Filing Status <br />N/A <br />N/A <br />Please check the appropriate box for the credit(s) and/or HOH filing status claimed on CTC/ HOH <br />N/A <br />audit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />the amount of the credit(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />and/or HOH filing status. <br />N/A <br />WESLEY C BROWN & SHANON M LARIMER 595-42-0794 <br />LEAH G JAMES, CPA, MSTAX P00230935 <br />X <br />X <br />X <br />X <br />X <br />X <br />RECORDS OF EXPENSES PROVIDED BY TAXPAYER <br />RECORDS OF GROSS RECEIPTS PROVIDED BY TAXPAYER <br />PLACEMENT AGENCY STATEMENT <br />X <br />X <br />X