Fillable Application for Taxpayer Identification Number for Pending U.S. Adoptions 2017 Form W-7A

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Application for Taxpayer Identification Number for Pending U.S. Adoptions 2017 Form W-7A

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The Application for Taxpayer Identification Number for Pending U.S. Adoptions 2017 Form W-7A form is 1 page long and contains:

  • 2 signatures
  • 2 check-boxes
  • 23 other fields

Country of origin: US
File type: PDF

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Form W-7A
(Rev. October 2017)
Department of the Treasury
Internal Revenue Service
Application for Taxpayer Identification Number
for Pending U.S. Adoptions
▶
Go to www.irs.gov/FormW7A for instructions and the latest information.
OMB No. 1545-0074
Note: Don't file this form if you are eligible to obtain a U.S. social security number (SSN) for your adoptive child.
1
Adoptive
parent(s)
information
(see instructions)
1a Parent’s last name First name Social security number
1b Parent’s last name First name Social security number
2
Adoptive
parent(s)
address
(see instructions)
Street address, apartment number, or rural route number. If you have a P.O. box, see the instructions.
City or town, state, and ZIP code
3
Child’s name:
As it will appear
▶
on your tax return
Birth name if different
and known . .
▶
3a Last name First name Middle name
3b Last name
First name Middle name
4
Child’s birth
information
Date of birth (month, day, year)
Female
Male
Place of birth (city or town, and state) (If foreign address, see instructions)
5
Placement
agency
information
Name Address
Date child
was placed
with adoptive
parents
Sign
Here
Note: Be sure to attach the required documentation to Form W-7A. See instructions.
Under penalties of perjury, I declare that I have examined this application, including accompanying documentation and statements, and to
the best of my knowledge and belief, it is true, correct, and complete.
Signature of parent
Keep a copy of this
form for your
records.
▲
Date (month, day, year) Daytime phone number
Signature of parent
▲
Date (month, day, year) Daytime phone number
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 24309E
Form
W-7A (Rev. 10-2017)
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signature
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dd mmm yyyy
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Application for Taxpayer Identification Number for Pending U.S. Adoptions 2017 Form W-7A

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Completed 18 May 2019

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