Form 502b Draft - Maryland Dependents' Information - 2012
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1
22012
FORM
Maryland Dependents' Information
502B
(Attach to Form 502, 505 or 515)
Social Security number
Spouse's Social Security number
Your first name
Initial Last name
Spouse’s first name
Initial Last name
Summary
1. Enter the total number of boxes checked below for Regular dependents (6) . . . . . . . . . . . . . . . . . . . .
1. ________________
2. Enter the total number of additional boxes checked below for dependents 65 or over (7) . . . . . . . . . . .
2. ________________
3. Total dependent exemptions (Add lines 1 and 2 and enter the total here and on line (C) of the
Exemptions area of Form 502, 505 or 515) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. ________________
Dependents (If a dependent listed below is age 65 or over, please check both boxes 6 and 7.)
1.
Initial
Last name
First name
2.
3.
Social Security number
Relationship
4.
if under 19
5. Has medical insurance?
Yes
No
6.
Regular
7.
65 or over
(For Form 502, resident taxpayers only)
1.
Initial
Last name
First name
2.
3.
Social Security number
Relationship
4.
if under 19
5. Has medical insurance?
Yes
No
6.
Regular
7.
65 or over
(For Form 502, resident taxpayers only)
1.
Initial
Last name
First name
2.
3.
Social Security number
Relationship
4.
if under 19
5. Has medical insurance?
Yes
No
6.
Regular
7.
65 or over
(For Form 502, resident taxpayers only)
1.
Initial
Last name
First name
2.
3.
Social Security number
Relationship
4.
if under 19
5. Has medical insurance?
Yes
No
6.
Regular
7.
65 or over
(For Form 502, resident taxpayers only)
COM/RAD-026
12-49
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