,t#a-bjjf ,s*$ule #e--,details ( ,dep5dant ,see ! guide 6f9d \ if y c claim an am.t on l9es #cje1 #cjf1 #cae1 &/or #cca ( ,s*$ule #a4 ,6calculate ! am.t y claim on l9e #cje1 #cjf1 or #cae1 -plete ! applica# *>t on ! ,f$]al ,"w%eet : y w f9d 9 ! =ms book4 ,6calculate ! am.t = l9e #cca1 r1d ! 9/ruc;ns = l9e #cca 9 ! guide4 ,= ea* dep5dant claim$ on l9es #cje1 #cjf1 #cae1 &/or #cca1 provide ! details reque/$ 2l4 ,atta* a copy ( ? s*$ule 6yr return4 ,l9e #cje--,am.t = an eligi# dep5dant ,if yr m>ital /atus *ang$ 9 #bjjf1 give ! date (! *ange4 7,mon?/,"d7 ---- 7,d n =get 6*eck ! box on page #a ( yr return 69dicate yr m>ital /atus47 #a ,s*$ule #e ,la/ "n ---- ,f/ "n ---- ,a4ress ---- ,date ( bir? 7,ye>/,mon?/,"d7 ---- ,rel,n%ip 6y ---- ,net 9come 9 #bjjf ---- ,nature (! 9firm;y 7if x applies7 ---- ,am.t ( claim 4#---- ,l9es #cjf1 #cae1 &/or #cca-- ,atta* a sep>ate %eet ( pap] if y ne$ m space4 ,la/ "n ---- ,f/ "n ---- ,a4ress ---- ,ye> ( bir? ---- ,rel,n%ip 6y ---- ,net 9come 9 #bjjf ---- ,nature (! 9firm;y 7if x applies7 ---- ,l9e claim$ ---- ,am.t ( claim 4#---- #b