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Get Dependent Care Documentation 2015-2024

/ Date of Birth: / / Name of care provider: PLEASE NOTE: A stipulation imposed by the IRS is that the service provider must be over 18 years of age and cannot be an individual for whom a personal tax exemption may be claimed. Address of provider: Taxpayer ID #: relationship to employee (if any): Spouse s name: Spouse s employer: Does your spouse make more than the amount you wish to withhold for daycare? Yes No You may not withhold more than your spouse.

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