Form 5129 
(Rev. December 2007)          Questionnaire—Filing Status, Exemptions, and Standard Deduction 
Section I.          Taxpayer Data 
1. Name(s) and address (exactly as shown on your income tax return)           2. Social Security Number                                3. Tax Form Number 

                                                                              4. Spouse’s Social Security Number                       5. Tax Year Ending 

Section II.          Filing Status and Standard Deduction 
Please check the appropriate box and answer the corresponding question(s) to show how you intended to file your tax return. 
1.   Single 
2.   Married filing joint return 
3.   Married filing separate return 
     a.             Did your spouse file a tax return for the tax year in Section I above? .  .  .  .  .  .  .                     Yes No   Unknown 
     b.             Please enter your spouse’s Social Security Number in Section I above and print 
                    your spouse’s name here as it appeared on that return 
     c.             Did you and your spouse live together at any time during the last 6 months of 
                    the year? .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . Yes No 
4.   Head of Household (with qualifying dependent) 
     (During the tax year, you provided more than half the cost of maintaining a household for a qualifying dependent.) 
     a.             If the qualifying person is your child, but is being claimed by the other parent, 
                    enter this child’s name here: .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . 
     b.             At the end of the tax year in Section I, above, you were: 
                    Unmarried                     Widowed           Legally Separated                                              Married to a Nonresident Alien 
                    You claimed your married child, grandchild, great-grandchild, etc., to include stepchild or adopted child who qualifies 
                    as your dependent. 
                    You claimed your married child, grandchild, great-grandchild, etc., adopted child, or stepchild who is not claimed 
                    as a dependent, due to your divorce or separation from the other parent who is claiming the child as a dependent. 
                    You claimed your foster child who is qualified as your dependent. 
                    You claimed any other relative who is qualified as your dependent. 
     c.             The household mentioned in Item 4a, above, was: 
                    Your household. 
                    The home you maintained for your parent who can be claimed as your dependent. 
     d.             Did you and your spouse live together at any time during the last 6 
                    months of the tax year? .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .     Yes No 
5.   Qualifying widow(er) with dependent child            .  .  .  .  .  .  .  .  .  .  .  What year did your spouse die? 
Section Ill.        Exemptions for Dependents and Standard Deduction 
Please give complete information below for each person you claimed as a dependent on your return for the tax year shown in Section 1. 
The names and Social Security Numbers you provide below must be written as they appear on the Social Security Card(s) issued by the Social 
Security Administration. If you need additional space or have made changes to any of these items, please use the back of this form to continue 
and/or explain your entries. 
                    1. First and Last Name                 2. Social Security Number             3. Dependent’s                        4. Check box if dependent
                                                                                             Relationship to You                       qualifies for Child Tax Credit 

5.   Were you 65 or over at the end of the tax year shown in Section I, above?            .  .  .  .  .  .  .  .  .  .  .  .  .        Yes  No 
6.   Were you blind at the end of the tax year?   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .   Yes  No 
7.  Was your spouse 65 or older at the end of the tax year?       .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .        Yes  No 
8.  Was your spouse blind at the end of the tax year?     .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .       Yes  No 
9.   Did you intend to claim an exemption for your spouse? .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .            Yes  No 
10. Did your spouse have any gross income for the tax year?       .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .        Yes  No 
11. Can you be claimed as a dependent on another persons’   return for the tax year?         .  .  .  .  .  .  .  .  .  .              Yes  No 
12. Can your spouse be claimed as a dependent on another persons’             return for the tax year?   .  .  .  .  .  .              Yes  No 
                    Under penalties of perjury, I declare that I have examined this statement and to the best of my knowledge and belief, it is true, 
                    correct, and complete. 
Sign here           Your Signature                                  Spouse’s Signature                                                 Date 
(if filing jointly, 
both must sign) 
Form 5129 (Rev. 12-2007)                          Cat. No. 27391O             Department of the Treasury–Internal Revenue Service