First Name: | Last or Family Name | Date of Birth
(mm/dd/yyyy) | ITIN or SSN | Relationship to you (son, daughter, none, etc.) | Number of months lived with you in the U.S. | U.S. citizen, U.S. residentalien, U.S. national, or a resident of Canada, Mexico, or South Korea | Did person file joint return? | Did child provide more than 50% of their own support? | Did you provide more than 50% of their support? | Did the person have Gross Income of $4,000 or more? |