Maryland Form 502b - Dependents' Information - 2013 Page 2

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Dependents' Information
MARYLAND
Page 2
FORM
(Attach to Form 502, 505 or 515.)
502B
2013
NAME _______________________________________ SSN ___________________
Dependents
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.)
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
13-49

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