MARYLAND
FORM
502B
Your
Social Security Number Print Using Blue or Black Ink Only
2016
Dependents' Information
(Attach to Form 502, 505
or 515.)
Spouse's Social Security Number
Your First Name
Initial
Your Last Name
Spouse's First Name
Initial
Spouse's Last Name
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.)
First Name
Initial
1.
Last Name
Social Security Number 2.
Relationship
Regular
3.
First Name
4.
Initial
1.
65 or over
5.
Last Name
Social Security Number 2.
Relationship
Regular
3.
First Name
4.
Initial
1.
65 or over
2.
Last Name
Relationship
Regular
3.
First Name
4.
Initial
1.
65 or over
2.
Last Name
Relationship
Regular
3.
First Name
4.
Initial
1.
65 or over
2.
Last Name
Relationship
Regular
3.
First Name
4.
Initial
1.
65 or over
2.
Last Name
Relationship
3.
COM/RAD-026
DEPENDENT 5
5.
Social Security Number DEPENDENT 4
5.
Social Security Number DEPENDENT 3
5.
Social Security Number DEPENDENT 2
5.
Social Security Number DEPENDENT 1
Regular
4.
65 or over
5.
DEPENDENT 6
MARYLAND
FORM
502B
2016
Dependents' Information
(Attach to Form 502, 505
or 515.)
Page 2
NAMESSN
First Name
Initial
1.
Social Security Number 2.
1.
Last Name
Relationship
Regular
3.
4.
First Name
Initial
Social Security Number Relationship
2.
First Name
Regular
4.
Initial
5.
65 or over
2.
Last Name
Relationship
Regular
3.
First Name
4.
Initial
1.
65 or over
2.
Last Name
Relationship
Regular
3.
First Name
4.
Initial
1.
65 or over
2.
Last Name
Relationship
Regular
3.
First Name
4.
Initial
1.
65 or over
2.
Last Name
Relationship
3.
COM/RAD-026
DEPENDENT 11
5.
Social Security Number DEPENDENT 10
5.
Social Security Number DEPENDENT 9
5.
Social Security Number DEPENDENT 8
5.
Social Security Number DEPENDENT 7
Last Name
3.
1.
65 or over
Regular
4.
65 or over
5.
DEPENDENT 12