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Form 2441
Additional Form 2441 Information Statement 2013
Line 1 and 2
G
Attach to return (after all IRS forms)
Name(s) shown on return
Your social security number
Additional Persons or Organizations Who Provided Care
(a)
Care provider's
(b)
Address
(c)
Identifying
(d)
Amount paid
name (number, street, apt. no., city, state, and ZIP Code) number (see instructions)
(SSN above
or EIN below)
Last or Business
First Address
Last or Business
City State ZIP
First Address
Last or Business
City State ZIP
First Address
Last or Business
City State ZIP
First Address
Last or Business
City State ZIP
First Address
Last or Business
City State ZIP
Total. Enter on an available line on Form 2441 line 1.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Additional Qualifying Persons and Expenses
(c) Qualified expenses
you
(a)
Qualifying person's name
(b)
Qualifying person's incurred and paid in 2013 for
First Last social security number the person listed in column (a)
Total. Enter on an available line on Form 2441 line 2.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
First
Address
City
State
ZIP
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