Free Form 2120 (Rev. October 2005) - Federal

Form

2120

(Rev. October 2005)
Department of the Treasury Internal Revenue Service

Multiple Support Declaration
Attach to Form 1040 or Form 1040A.

OMB No. 1545-0074 Attachment Sequence No.

114

Name(s) shown on return

Your social security number

During the calendar year

, the eligible persons listed below each paid over 10% of the support of:

Name of your qualifying relative

I have a signed statement from each eligible person waiving his or her right to claim this person as a dependent for any tax year that began in the above calendar year.
Eligible person's name Social security number

Address (number, street, apt. no., city, state, and ZIP code)

Eligible person's name

Social security number

Address (number, street, apt. no., city, state, and ZIP code)

Eligible person's name

Social security number

Address (number, street, apt. no., city, state, and ZIP code)

Eligible person's name

Social security number

Address (number, street, apt. no., city, state, and ZIP code)

Instructions
What's New
The rules for multiple support agreements still apply to claiming an exemption for a qualifying relative, but they no longer apply to claiming an exemption for a qualifying child. For the definitions of "qualifying relative" and "qualifying child," see your tax return instruction booklet.

Note. To find out what is included in support, see Pub. 501, Exemptions, Standard Deduction, and Filing Information.

Signed Statement
You must have received, from each other eligible person listed above, a signed statement waiving his or her right to claim the person as a dependent for the calendar year indicated on this form. The statement must include: The calendar year the waiver applies to, The name of your qualifying relative the eligible person helped to support, and The eligible person's name, address, and social security number. Do not file the signed statement with your return. But you must keep it for your records and be prepared to furnish it and any other information necessary to show that you qualify to claim the person as your dependent.

Purpose of Form
Use Form 2120 to: Identify each other eligible person (see below) who paid over 10% of the support of your qualifying relative whom you are claiming as a dependent, and Indicate that you have a signed statement from each other eligible person waiving his or her right to claim that person as a dependent. An eligible person is someone who could have claimed a person as a dependent except that he or she did not pay over half of that person's support. If there are more than four other eligible persons, attach a statement to your return with the required information.

Additional Information
See Pub. 501 for details.
Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. You are required to give us the information. We need it to ensure that you are complying with these laws and to allow us to figure and collect the right amount of tax. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Internal Revenue Code section 6103. The average time and expenses required to complete and file this form will vary depending on individual circumstances. For the estimated averages, see the instructions for your income tax return. If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.

Claiming a Qualifying Relative
Generally, to claim a person as a qualifying relative, you must pay over half of that person's support. However, even if you did not meet this support test, you may be able to claim him or her as a dependent if all five of the following apply. 1. You and one or more other eligible person(s) (see above) together paid over half of that person's support. 2. You paid over 10% of the support. 3. No one alone paid over half of that person's support. 4. The other dependency tests are met. See Step 4, Is Your Qualifying Relative Your Dependent? in the Form 1040 or Form 1040A instructions. 5. Each other eligible person who paid over 10% of the support agrees not to claim that person as a dependent by giving you a signed statement. See Signed Statement on this page.

Cat. No. 11712F

Form

2120

(Rev. 10-2005)