Form 40
Dependents Statement
2013
Line 6c and Line 6d
Attach to your return
Statement
Name(s) shown on return
Social Security number (SSN)
6c All dependents:                                                   6d Disabled children only:
Check the boxes if
your dependents                     First names                                                     First names
are disabled children
Total number of dependents:
Total number of disabled children:
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