Fillable Form 2016: 502B Dependents' Information (Attach to Form (Comptroller of Maryland)

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Form 2016: 502B Dependents' Information (Attach to Form (Comptroller of Maryland)

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MARYLAND
FORM
502B
2016
Dependents' Information
(Attach to Form 502, 505
or 515.)
COM/RAD-026
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
DEPENDENT 1
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
DEPENDENT 2
DEPENDENT 3
DEPENDENT 4
DEPENDENT 5
DEPENDENT 6
Summary
1. Enter the total number checked below for Regular dependents (4) ............................ 1.
2. Enter the total number checked below for dependents 65 or over (5) .......................... 2.
3. Total dependent exemptions (Add lines 1 and 2 and enter the total here and on line (C) of the
Exemptions area of Form 502, 505 or 515.) .............................................3.
Dependents (If a dependent listed below is age 65 or over, please check both 4 and 5.)
1.
2. 3. 4. 5.
1.
2. 3. 4. 5.
1.
2. 3. 4. 5.
1.
2. 3. 4. 5.
1.
2. 3. 4. 5.
1.
2. 3. 4. 5.
Your Social Security Number Spouse's Social Security Number
Your First Name Initial
Your Last Name
Spouse's First Name Initial
Spouse's Last Name
Print Using Blue or Black Ink Only
MARYLAND
FORM
502B
2016
Dependents' Information
(Attach to Form 502, 505
or 515.)
COM/RAD-026
Page 2
DEPENDENT 7
DEPENDENT 8
DEPENDENT 9
DEPENDENT 10
DEPENDENT 11
DEPENDENT 12
NAME SSN
1.
2. 3. 4. 5.
1.
2. 3. 4. 5.
1.
2. 3. 4. 5.
1.
2. 3. 4. 5.
1.
2. 3. 4. 5.
1.
2. 3. 4. 5.
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
First Name Initial Last Name
Social Security Number Relationship Regular 65 or over
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Form 2016: 502B Dependents' Information (Attach to Form (Comptroller of Maryland)

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Completed 14 August 2020

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