If you are eligible for the Earned Income Tax Credit because your children live with you for more than 6 months during the year

and

you owe the State** child support for these same children,

and

the State takes your tax refund to repay this child support (or you expect the State will take your tax refund),

you can get your tax refund back.

Here’s how: Fill out the form below and send it to

Support Enforcement

999 Asylum Avenue

Hartford, CT 06105

NOTE: If you have been chosen for the IRS Certification Test Program, you should send the form below PLUS a copy of the same information you sent to the IRS to show you should get the EITC in the first place.

** The State will still intercept tax refunds for child support owing to the other parent.

_______________

(Date)

_______________ v. _________________________

(Your name) (Name of other parent)

________________________

(Your Social Security number)

The child/ren named below lived with me for at least six months of the year 2004:

__________________________________________________

(names of child/ren)

I am enclosing a copy of proof that they lived with me.

Please return my tax refund to me. My address is:

______________________________________

______________________________________

______________________________________