Determination of Head of Household
Complete this form to determine your Head of Household filing qualifications for Tax Year.
Taxpayer Name
*
First Name
Last Name
Were You Married At Any Time During The Tax Year?
*
Yes
No
Do You Have A Child Or Children Living With You?
*
Yes
No
How Many Months Did Each Child Live With You During The Tax Year?
How Old Is Each Child That Lived With You?
What Is The Relationship Of Each Person That Lived With You?
Did Anyone Else Share The Household With You?
Yes
No
What Portion Of The Rent And Utilities Did You Pay?
What Portion Of The Groceries Did You Buy?
Taxpayer Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: