SPOUSE INFORMATION
First Name Last Name Birth Date Social Security Number Gender Boy Girl Relationship to You? Son Daughter Grandchild Foster child Sister Brother Niece Nephew Parent Grandparent Aunt Uncle Step Child Half Brother Half Sister Step Brother Step Sister Other Months lived with You? 1 2 3 4 5 6 7 8 9 10 11 12 Diabled Dependent Care Expenses Fulltime Student DEPENDENT # 2 First Name Last Name Birth Date Social Security Number Gender Type Option 1 Type Option 2 Type Option 3 Relationship to You? Type Option 1 Type Option 2 Type Option 3 Months lived with You? Type Option 1 Type Option 2 Type Option 3 First Name Disabled Dependent Care Expenses Fulltime Student DEPENDENT # 3 First Name Last Name Birth Date Social Security Number Gender Type Option 1 Type Option 2 Type Option 3 Relationship to You? Type Option 1 Type Option 2 Type Option 3 Months lived with You? Type Option 1 Type Option 2 Type Option 3 TDisabled Dependent Care Expenses Fulltime Student
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SELF-EMPLOYMENT
If you are filing Self-Employment income, you are required to complete the Self-Employment statement and sign for authorization.
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