Schedule Ch Individual Red - Release Of Claim To Exemption For Child (Children) Of Divorced Or Separated Parents - 2005

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Schedule CH Individual
E
C
0
5
0
0
2005
Rev. 05.05
RELEASE OF CLAIM TO EXEMPTION FOR CHILD (CHILDREN) OF DIVORCED OR
SEPARATED PARENTS
Taxable year beginning on __________________________________ , ________ and ending on ____________________________________ , ________
Social Security Number
Name of parent claiming the exemption
Part I:
Release of Claim to Exemption for Dependents for Current Year
(See instructions)
I, ______________________________________________________, agree and promise not to claim an exemption for dependents for
Name of parent releasing claim to exemption
taxable year 2005 for (enter the name(s) of child (children)):
(1)___________________________________________________________________
(2)___________________________________________________________________
(3)___________________________________________________________________
(4)___________________________________________________________________
(5)___________________________________________________________________
____________________________________________
_________________________
________________
Signature of parent releasing claim to exemption
Social Security Number
Date
If you choose not to claim an exemption for this (these) child (children) for future taxable years, complete Part II.
Part II:
Release of Claim to Exemption for Dependents for Future Years
(See instructions)
I, ______________________________________________________, agree and promise not to claim an exemption for dependents for
Name of parent releasing claim to exemption
taxable year(s) ________________________ for (enter the name(s) of child (children)):
(Specify)
(1)___________________________________________________________________
(2)___________________________________________________________________
(3)___________________________________________________________________
(4)___________________________________________________________________
(5)___________________________________________________________________
____________________________________________
_________________________
________________
Signature of parent releasing claim to exemption
Social Security Number
Date
Conservation Period: Ten (10) years

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