Form 80-491-11-5-1-000 - Individual Income Tax Statement Of Additional Dependents - 2011

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Scanband Version of Form 80-491-11-5-1-000
Individual Income Tax Statement
Additional Dependents
There must be data in all fields of the scanband. There cannot be any handwritten
information on these forms. The preparer or taxpayer should not be able to print
this form with data missing from the scanband.
We have tried to include the changes from the previous year in this list, but we may have missed a few. Please check
the form as well as this list.
1) Updated barcode, year, and form number.
2) Added Duplex or Photocopies not Acceptable.
3) Added more lines for dependent name
4) Updated the agency name

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