Schedule Ch Individual - Transfer Of Claim For Exemption For Child (Children) Of Divorced Or Separated Parents - 2012

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Schedule CH Individual
TRANSFER OF CLAIM FOR EXEMPTION FOR CHILD
Rev. Feb 19 13
(CHILDREN) OF DIVORCED OR
2012
SEPARATED PARENTS
Taxable year beginning on ____________________ , ________ and ending on _______________________ , ________
Taxpayer's name
Social Security Number
Fill in the joint custody oval if the dependent is subject to this condition.
47
I, ______________________________________________________, agree and promise not to claim an exemption for dependents for
Name of parent releasing claim to exemption
taxable year 2012 for (enter the name(s) of child (children)):
Name, Initial
Last
Second
Social Security Number
Joint
Custody
Name
Last Name
(01)
(02)
(03)
(04)
(05)
(06)
(07)
(08)
(09)
(10)
______________________________________________________
____________________________________
______________________________
(11)
Signature of parent releasing claim to exemption
Social Security Number
Date
Retention Period : Ten (10) years

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