Massachusetts Form 1 Draft - Schedule X, Schedule Y, Schedule Z, Schedule Di - 2008 Page 3

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SOCIAL SECURITY NUMBER
Schedule DI
Dependent Information
Enclose with Form 1 or Form 1-NR/PY. Do not cut or separate these schedules.
You must complete this schedule if you are claiming a dependent exemption(s) on Form 1, line 2b or Form 1-NR/PY, line 4b or taking a deduction/
credit(s) on Form 1, lines 12, 13 or 40 or Form 1-NR/PY, lines 16, 17 or 45. Complete information below for each dependent. Do not include yourself
or your spouse. If you are claiming more than 10 dependents, see instructions.
1. SOCIAL SECURITY NUMBER
1. FIRST NAME
M.I.
LAST NAME
DATE OF BIRTH
RELATIONSHIP TO TAXPAYER
IS DEPENDENT A QUALIFYING CHILD FOR EARNED INCOME CREDIT?
Yes
3
2. SOCIAL SECURITY NUMBER
2. FIRST NAME
M.I.
LAST NAME
DATE OF BIRTH
RELATIONSHIP TO TAXPAYER
IS DEPENDENT A QUALIFYING CHILD FOR EARNED INCOME CREDIT?
Yes
3
3. SOCIAL SECURITY NUMBER
3. FIRST NAME
M.I.
LAST NAME
DATE OF BIRTH
RELATIONSHIP TO TAXPAYER
IS DEPENDENT A QUALIFYING CHILD FOR EARNED INCOME CREDIT?
Yes
3
4. SOCIAL SECURITY NUMBER
4. FIRST NAME
M.I.
LAST NAME
DATE OF BIRTH
RELATIONSHIP TO TAXPAYER
IS DEPENDENT A QUALIFYING CHILD FOR EARNED INCOME CREDIT?
Yes
3
DRAFT AS OF
5. SOCIAL SECURITY NUMBER
5. FIRST NAME
M.I.
LAST NAME
SEPTEMBER 11, 2008
DATE OF BIRTH
RELATIONSHIP TO TAXPAYER
IS DEPENDENT A QUALIFYING CHILD FOR EARNED INCOME CREDIT?
Yes
3
6. SOCIAL SECURITY NUMBER
6. FIRST NAME
6
M.I.
LAST NAME
(SUBJECT TO CHANGE)
DATE OF BIRTH
RELATIONSHIP TO TAXPAYER
IS DEPENDENT A QUALIFYING CHILD FOR EARNED INCOME CREDIT?
Yes
3
7. SOCIAL SECURITY NUMBER
7. FIRST NAME
M.I.
LAST NAME
DATE OF BIRTH
RELATIONSHIP TO TAXPAYER
IS DEPENDENT A QUALIFYING CHILD FOR EARNED INCOME CREDIT?
Yes
3
8. SOCIAL SECURITY NUMBER
8. FIRST NAME
M.I.
LAST NAME
DATE OF BIRTH
RELATIONSHIP TO TAXPAYER
IS DEPENDENT A QUALIFYING CHILD FOR EARNED INCOME CREDIT?
Yes
3
9. SOCIAL SECURITY NUMBER
9. FIRST NAME
M.I.
LAST NAME
DATE OF BIRTH
RELATIONSHIP TO TAXPAYER
IS DEPENDENT A QUALIFYING CHILD FOR EARNED INCOME CREDIT?
Yes
3
10. SOCIAL SECURITY NUMBER
10. FIRST NAME
M.I.
LAST NAME
DATE OF BIRTH
RELATIONSHIP TO TAXPAYER
IS DEPENDENT A QUALIFYING CHILD FOR EARNED INCOME CREDIT?
Yes
3

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