Tax Dependency Claim Release Form

Tax Dependency Claim Release Form
Complete this form to formally release your claim to a tax dependency for a specified tax year.
Your Full Name (Releasing Party)
First NameLast Name
Your Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Your Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your Email Address
example@example.com
Dependent's Full Name
First NameLast Name
Relationship to Dependent
Person Receiving Claim (Full Name)
First NameLast Name
Recipient's Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Tax Year(s) for Release
Additional Comments or Special Instructions (optional)
Signature of Releasing Party
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Should be Empty: