Clients with Dependents (If you are a new client or are adding a new dependent, we will need a copy of the social security card.) Name of Dependent Date of Birth Relationship to you # of months lived in your home Is Dependent US Citizen Single or Married Full Time Student Disabled Can anyone else claim Dependent *If full time college student, include tuition statement (1098T). Were education credits claimed in the past? Yes/No If yes, how many years____*If you have daycare expenses, provide statement with the provider name, address, phone #, SSN or EIN & the amount paid for the year. * If relationship is other than son or daughter please answer the following questions. -If biological parents are not living with the child where are the parents? Dad _____________________Mom __________________ - Can you provide documentation (birth certificate/marriage certificate) to prove your relationship to the child? Yes/No - Did you make more money than the parent(s) of the child? Yes/No * If asked could you provide IRS with any of the following showing proof the child lived at your address? Yes/No - If yes, check those that apply to you. School records _____ Medical records _____ Social Services _____ Daycare records _____

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