Schedule Ch Individual - Release Of Claim To Exemption For Child Of Divorced Or Separated Parents

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Schedule CH
Individual
8
C
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9
V
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8
C
200 ___
Rev. 05.02
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
Release of Claim to Exemption for Dependents for Current Year
Part I:
(See instructions)
I, ______________________________________________ , agree and compromise not to claim an exemption for dependents for
Name of parent releasing claim exemption
the taxable year 200__ for (enter the name(s) of child(children)):
(1)___________________________________________________________________
(2)___________________________________________________________________
(3)___________________________________________________________________
(4)___________________________________________________________________
(5)___________________________________________________________________
____________________________________________
_________________________
________________
Signature of parent releasing claim 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.
Release of Claim to Exemption for Dependents for Future Years
Part II:
(See instructions)
I, ______________________________________________ , agree and compromise not to claim an exemption for dependents for
Name of parent releasing claim exemption
the taxable year(s)_______________________ for (enter the name(s) of child(children)):
(Specify)
(1)___________________________________________________________________
(2)___________________________________________________________________
(3)___________________________________________________________________
(4)___________________________________________________________________
(5)___________________________________________________________________
____________________________________________
_________________________
________________
Social Security Number
Signature of parent releasing claim exemption
Date
Conservation Period: Ten (10) years

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