Download:
pdf |
pdfW-7A
Application for Taxpayer Identification Number
for Pending U.S. Adoptions
Form
(Rev. October 2017)
Department of the Treasury
Internal Revenue Service
▶
OMB No. 1545-0074
Go to www.irs.gov/FormW7A for instructions and the latest information.
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
1a Parent’s last name
First name
Social security number
1b Parent’s last name
First name
Social security number
(see instructions)
2
Adoptive
parent(s)
address
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
(see instructions)
3
4
5
Child’s name:
3a Last name
As it will appear
▶
on your tax return
3b Last name
Birth name if different
▶
and known . .
Date of birth (month, day, year)
Child’s birth
information
Placement
agency
information
Sign
Here
Middle name
First name
Middle name
Place of birth (city or town, and state) (If foreign address, see instructions)
Male
Name
Address
Date child
was placed
with adoptive
parents
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
Date (month, day, year)
Daytime phone number
Signature of parent
Date (month, day, year)
Daytime phone number
▲
Keep a copy of this
form for your
records.
Female
First name
▲
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 24309E
Form W-7A (Rev. 10-2017)
File Type | application/pdf |
File Title | Form W-7A (Rev. October 2017) |
Subject | Fillable |
Author | SE:W:CAR:MP |
File Modified | 2017-10-24 |
File Created | 2017-10-24 |