Taxpayer's Name
Possible Dependent's Name
Tax Year


Funds Belonging to the Person You Supported Totals
- Amount in savings and other accounts at the beginning of the year
- Income received (taxable and non-taxable)
- Amount borrowed during the year
1 Total funds belonging to the person you supported
2 Amount from person's funds used for his/her support
3 Amount from person's funds used for other purposes
4 Amount in person's savings and other accounts
at the end of the year
5 Amount spent during the year and remaining at end of year.
Should equal Total Funds above


Expenses for the Entire Household
(Where the person you supported lived)		 Monthy No. of
Months		 Annually Totals
6 Lodging (generally a. or b. below, but see note at bottom)
- a. Rent Paid or
- b. Fair Rental Value of Home Get Fair Market Rental Value Here! or
- If the person you supported owned the home, enter Y here
- Logding Total
7 Food Expenses or
8 Utilities not included in Lodging above
- Electric or
- Natural Gas or
- Water/Sewer or
- Garbage or
- Other or
- Utilities Total
9 Total Amount of repairs (not included in Lodging, above)
10 Total other expenses. Do not include expense of maintaining
the home, such as mortgage interest, real estate taxes, and insurance.
11 Total Household Expenses
12 Total number of persons who lived in the household


Expenses for the Person You Supported Monthy No. of
Months		 Annually Totals
13 This person's share of household expenses
14 This person's total clothing expenses or
15 This person's total education expenses or
16 This person's total medical and dental expenses or
17 This person's total travel and recreational expenses or
18 This person's total other expenses or
19 Total cost of this person's support for the year




Did the Person Provide More Than Half of His or Her Own Support?
20 Half of the Person's support
21 Amount supplied by the person
22 Did the person provide more than half? ?
  • If NO, you meet the support test for this person to be your qualifying child. If this person also meets the other tests to be a qualifying child, stop here. Otherwise, fill in the Amount Provided by Others, below, and recalculate to determine if this person is your qualifying relative.

  • If YES, you do not meet the support test for this person to be either your qualifying child or your qualifying relative. Stop here


Did You Provide More than Half of this Person's Support?
23 Amount Provided by Others for the person's support. Include amounts
provided by state, local, and other welfare societies or agencies. Do not
include any amounts included in line 1.
24 Amount provided by person and others
25 Amount you provided (total cost of person's support minus what was provided
by person and others)
26 Did You provide more than half? ?
  • If YES, you meet the support test for this person to be your qualifying relative.

  • If NO, you do not meet the support test for this person to be your qualifying relative. You cannot claim an exemption for this person unless you can do so under a multiple support agreement, the support test for children of divorced or separated parents, or the special rule for kidnapped children.


Lodging Note Generally, you either pay rent or one or more members of the household own the home. Renters will complete the Rent Paid line; homeowners will complete the Fair Market Value line. If the rent/own situation changes during the year, you may have entries on both lines 6a. and b.