Form It-40/it-40pnr - Schedule In-Dep - Additional Dependent Child Information - 2014
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1Schedule IN-DEP: Additional Dependent Child Information
Schedule IN-DEP
Enclosure
Form IT-40/IT-40PNR
2014
Sequence No. 06A
State Form 54815
(R3 / 9-14)
Name(s) shown on Form IT-40/IT-40PNR
Your Social Security Number
Report on this schedule the first and last name and Social Security number for each dependent child claimed as an additional exemp-
tion on line 2 of Schedule 3 (from Form IT-40) or Schedule D (from Form IT-40PNR).
Child’s
Child’s
Child’s
First Name
Last Name
Social Security Number
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4.
5.
6.
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*25614111694*
25614111694
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