EFTA01222624.pdf

Form2120 Multiple Support Declaration OMB No. 1545-0074 (Rev. October 2005) Attachment 0eservnes of me rreasurY Normal Revamp Service ► Attach to Form 1040 or Form 1040A. Sequence Na 114 Name(s) shown on return Vote social security number During the calendar year the eligible persons listed below each paid over 10% of the support of: Name of yaw qualifying relative I have a signed statement from each eligible person waiving his or her right to claim this person as a dependent for any tax year that began in the above calendar year. Eligible person's name Social security number Address (number, street. apt. no.. city. state. and ZIP code) Eligible person's name Social security number Address (number, street. apt. no.. city, state. and ZIP code) Eligible person's name Social security number Address (number, street. apt. no.. city, state. and ZIP code) Eligible person's name Social security number Address (number, street. apt. no.. city. state. and ZIP code) Form 2120 (Rev. 10-2005) EFTA01222624