Form It-40/it-40pnr - Schedule In-Dep - Additional Dependent Child Information - 2013
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1Schedule IN-DEP
Schedule IN-DEP: Additional Dependent Child Information
Enclosure
Form IT-40/IT-40PNR
Sequence No. 06A
2013
See instructions: IT-40 booklet, page 26
State Form 54815
IT-40 PNR booklet, page 28
(R2 / 9-13)
Name(s) shown on Form IT-40/IT-40PNR
Your Social Security Number
Report on this schedule the fi rst 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
1.
2.
3.
4.
5.
6.
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25613111694
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