Form 482.0 R - Individual Income Tax Return - 2001 Page 5
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28Schedule A 1 Individual
DEPENDENTS AND BENEFICIARIES
Rev. 05.01
200__
OF EDUCATIONAL CONTRIBUTION
ACCOUNTS
Taxable year beginning on ____________ , _____ and ending on ___________ , _____
Taxpayer’s name
Social Security Number
Part I
Part I
Part I
Dependents Information
Dependents Information
Dependents Information
Part I
Part I
Dependents Information
Dependents Information
(See instructions)
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First Name, Initial
Last Name
Second Last Name
Date of Birth
Category
Social Security Number
Head of
Head of
Head of
Head of
Head of
Relationship
(01)
J J J J J
Household
Household
Household
Household
Household
NOT THE
NOT THE
NOT THE
NOT THE
NOT THE
TAXPAYER / NOT THE
TAXPAYER / NOT THE
TAXPAYER / NOT THE
TAXPAYER / NOT THE
TAXPAYER / NOT THE
SPOUSE
SPOUSE
SPOUSE
SPOUSE
SPOUSE
First Name, Initial
Date of Birth
Relationship
(N) (U) (I)
(N) (U) (I)
(N) (U) (I)
Social Security Number
Last
Second Last
Category
(N) (U) (I)
(N) (U) (I)
Name
Name
Day / Month / Year
See instructions
(02)
(03)
(04)
(05)
(06)
(07)
(08)
(09)
(10)
IMPORTANT INFORMATION PART I
IMPORTANT INFORMATION PART I
IMPORTANT INFORMATION PART I
IMPORTANT INFORMATION PART I
IMPORTANT INFORMATION PART I
,
Do not include the spouse in this schedule
Do not include the spouse in this schedule
Do not include the spouse in this schedule
Do not include the spouse in this schedule
Do not include the spouse in this schedule. A married individual who lives with his spouse is not a head of household
A married individual who lives with his spouse is not a head of household
A married individual who lives with his spouse is not a head of household
A married individual who lives with his spouse is not a head of household
A married individual who lives with his spouse is not a head of household
for tax purposes, therefore, you should not include the wife’s name on the box for head of household (line 01).
for tax purposes, therefore, you should not include the
for tax purposes, therefore, you should not include the
name on the box for head of household (line 01).
name on the box for head of household (line 01).
name on the box for head of household (line 01).
for tax purposes, therefore, you should not include the
for tax purposes, therefore, you should not include the
name on the box for head of household (line 01).
,
If a dependent entitles you the head of household filing status, do not claim him/her as a dependent
If a dependent entitles you the head of household filing status, do not claim him/her as a dependent
If a dependent entitles you the head of household filing status, do not claim him/her as a dependent.
If a dependent entitles you the head of household filing status, do not claim him/her as a dependent
If a dependent entitles you the head of household filing status, do not claim him/her as a dependent
,
In order to consider the exemption for dependents you must include this schedule with your return.
In order to consider the exemption for dependents you must include this schedule with your return.
In order to consider the exemption for dependents you must include this schedule with your return.
In order to consider the exemption for dependents you must include this schedule with your return.
In order to consider the exemption for dependents you must include this schedule with your return.
Part II
Part II
Part II
Beneficiaries of Educational Contribution Accounts
Beneficiaries of Educational Contribution Accounts
Beneficiaries of Educational Contribution Accounts
Part II
Part II
Beneficiaries of Educational Contribution Accounts
Beneficiaries of Educational Contribution Accounts
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(See instructions)
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Relationship
Contributed Amount
Name, Initial
Last
Second Last
Date of Birth
Social Security
Number
Name
Name
Day / Month / Year
(01)
(02)
(03)
(04)
(05)
Total contributions
Total contributions
Total contributions
Total contributions (Add lines (01) through (05) and transfer to Part 3, line 7H of the Short Form
Total contributions
(10)
or to Schedule A Individual, Part II, line 8 of the Long Form) ....................................................
IMPORTANT INFORMATION PART II
IMPORTANT INFORMATION PART II
IMPORTANT INFORMATION PART II
IMPORTANT INFORMATION PART II
IMPORTANT INFORMATION PART II
,
These beneficiaries must not be considered to determine the exemption for dependents. However, if any of these beneficiaries
These beneficiaries must not be considered to determine the exemption for dependents. However, if any of these beneficiaries
These beneficiaries must not be considered to determine the exemption for dependents. However, if any of these beneficiaries
These beneficiaries must not be considered to determine the exemption for dependents. However, if any of these beneficiaries
These beneficiaries must not be considered to determine the exemption for dependents. However, if any of these beneficiaries
qualifies as your dependent, you must include him/her in Part I of this Schedule.
qualifies as your dependent, you must include him/her in Part I of this Schedule.
qualifies as your dependent, you must include him/her in Part I of this Schedule.
qualifies as your dependent, you must include him/her in Part I of this Schedule.
qualifies as your dependent, you must include him/her in Part I of this Schedule.
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