I guess you wanted to go on Jan 5th 2004 and not Dec 5th 2004 if I am right?
Following documents are required for interim EAD.
1. Passport
2. Original or Copy of I765 Receipt notice with more than 90 calendar days of Receipt date.
3. Original or Copy of I485 Receipt notice
4. Local Photo Id; MA Driving licence. If you are from any other state you may show Passport as your Id.
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