Form 1040
Additional Dependents Statement                                               2013
Line 6c
G
 Attach to return (after all IRS forms)
Statement
Name(s) shown on return
Your social security number
Dependents:
                          (1)                                                                            (2)                                       (3)                                               (4)
 
First name                   Last name                                Dependent's                  Dependent's                         
b
 if qualifying
social security                  relationship                             child for
number                          to you                            child tax credit
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