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    4                                                                                                                            NEAR FINAL DRAFT 8/1/24                                                            4
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    6                                                                                                                                                                               *241601*6
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          2024 Schedule M1DQC, Dependents and Qualifying Children 
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    9     Use this schedule to provide information about your dependents and qualifying children. If you need to list more than three, provide a separate                                                           9
    10    statement with the additional dependents and qualifying children.                                                                                                                                         10
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    12                                                                                                                                                                                                              12
    13 YOUR FIRST NAME,INITXXXXXX LAST NAMEXXXXXXXXXXXXXXXXXXX 999999999                                                                                                                                            13
    14    Your First Name and Initial                                                                                         Last Name                                    Social Security Number                   14
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    16                                                                                                                             A — Child 1                 B — Child 2                 C — Child 3              16
    17                                                                                                                                                                                                              17
    18    First name and middle initial   ................... a1                                                                        12345678          b1    12345678    c1                    12345678          18
    19                                                                                                                                                                                                              19
    20    Last name  ................................. a2                                                                               12345678           b2   12345678    c2                    12345678          20
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    22    Social Security Number or Individual Taxpayer                                                                                                                                                             22
    23    Identification Number .......................... a3                                                                           12345678        b3      12345678    c3                    12345678          23
    24                                                                                                                                                                                                              24
    25    Date of Birth                                                                    .................................. a4        12345678           b4   12345678    c4                    12345678          25
    26                                                                                                                                                                                                              26
    27    Relationship to you  ............................ a5                                                                          12345678      b5        12345678               c5         12345678          27
    28                                                                                                                                                                                                              28
    29    Check the box if you are                                                                                                                                                                                  29
    30    claiming them as a ................ dependent                                                                 a6       X                      b6    X                     c6     X                        30
    31                                                                                                                                                                                                              31
    32    Number of months they lived with you                                                        .......... a7                     12345678      b7        12345678               c7         12345678          32
    33                                                                                                                                                                                                              33
    34    Check the box if they were over age                                                                                                                                                                       34
    35    but17       under age and24      a full-time student  .....                                                   a8       X                      b8    X                     c8     X                        35
    36                                                                                                                                                                                                              36
    37    Check the box if they were permanently                                                                                                                                                                    37
    38    and               totally disabled anyin                   part of 2024  ........                             a9       X                      b9    X                     c9     X                        38
    39                                                                                                                                                                                                              39
    40    Check the box arethey if         a qualifying ..... a10 child                                                          X                      b10   X                     c10    X                        40
    41                                                                                                                                                                                                              41
    42    Check boxthe          if arethey a qualifying child older                                                      a11     X                      b11   X                     c11    X                        42
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    63                                                                                                                                    9995                                                                      63
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