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                                             Multiple Support Declaration                                                                  OMB No. 1545-0074 
Form  2120
(Rev. October 2018)                                            ▶ Attach to Form 1040.                                                      Attachment  
Department of the Treasury                 ▶ Go to www.irs.gov/Form2120 for the latest information.                                        Sequence No.  114 
Internal Revenue Service 
Name(s) shown on return                                                                                                           Your social security number 

During the calendar year                                                  , the eligible persons listed below each paid over 10% of the support of: 

                                                               Name of your qualifying relative 
I have a signed statement from each eligible person waiving his or her right to claim this person as a dependent for any tax year that 
began in the above calendar year. 

Eligible person’s name                                                                                                            Social security number

Address (number, street, apt. no., city, state, and ZIP code) 

Eligible person’s name                                                                                                            Social security number

Address (number, street, apt. no., city, state, and ZIP code) 

Eligible person’s name                                                                                                            Social security number

Address (number, street, apt. no., city, state, and ZIP code) 

Eligible person’s name                                                                                                            Social security number

Address (number, street, apt. no., city, state, and ZIP code) 
Instructions                                                                         4.  The other dependency tests are met. See Step 4, Is YourQualifying 
                                                                                     Relative Your Dependent? in the Instructions for Form 1040. 
What’s New                                                                           5.  Each other eligible person who paid over 10% of the supportagrees 
Exemption deduction suspended. The deduction for personal exemptions                 not to claim that person as a dependent by giving you asigned statement. 
is suspended for tax years 2018 through 2025 by the Tax Cuts and Jobs Act.           See Signed Statement on this page. 
Although taxpayers can’t claim a deduction for exemptions, eligibility for the 
exemption remains important for determining who may claim the credit for             Note: To find out what is included in support, see Pub. 501. 
other dependents, as well as other tax benefits. See the instructions and            Signed Statement 
Pub. 501 for details.
                                                                                     You must have received, from each other eligible person listed above, a 
Purpose of Form                                                                      signed statement waiving his or her right to claim the person as a dependent 
Use Form 2120 to:                                                                    for the calendar year indicated on this form. The statement must include: 
• Identify each other eligible person (see below) who paid over 10% of the           • The calendar year the waiver applies to, 
support of your qualifying relative whom you are claiming as a dependent,            • The name of your qualifying relative the eligible person helped to support, 
and                                                                                  and 
• Indicate that you have a signed statement from each other eligible person          • The eligible person’s name, address, and social security number. 
waiving his or her right to claim that person as a dependent.                        Don’t file the signed statement with your return. But you must keep it for your 
An eligible person is someone who could have claimed a person as a                   records and be prepared to furnish it and any other information necessary to 
dependent except that he or she didn’t pay over half of that person’s                show that you qualify to claim the person as your dependent.  
support. 
If there are more than four other eligible persons, attach a statement to            Additional Information 
your return with the required information.                                           See Pub. 501 for details. 
Note: The rules for multiple support agreements apply to claiming an 
exemption for a qualifying relative and don't apply to claiming an exemption         Paperwork Reduction Act Notice. We ask for the information on this form 
for a qualifying child. For the definitions of “qualifying relative” and “qualifying to carry out the Internal Revenue laws of the United States. You are required 
child,” see the instructions for your tax return and Pub. 501.                       to give us the information. We need it to ensure that you are complying with 
                                                                                     these laws and to allow us to figure and collect the right amount of tax. 
Claiming a Qualifying Relative                                                       You aren’t required to provide the information requested on a form that is 
Generally, to claim a person as a qualifying relative, you must pay over half of     subject to the Paperwork Reduction Act unless the form displays a valid 
that person’s support. However, even if you didn’t meet this support test,           OMB control number. Books or records relating to a form or its instructions 
you may be able to claim him or her as a dependent if all five of the following      must be retained as long as their contents may become material in the 
apply.                                                                               administration of any Internal Revenue law. Generally, tax returns and return 
1.  You and one or more other eligible person(s) (see above) together paid           information are confidential, as required by Internal Revenue Code section 
over half of that person’s support.                                                  6103. 
2.  You paid over 10% of the support.                                                The average time and expenses required to complete and file this form will 
                                                                                     vary depending on individual circumstances. For the estimated averages, see 
3.  No one alone paid over half of that person’s support.                            the instructions for your income tax return. 
                                                                                     If you have suggestions for making this form simpler, we would be happy 
                                                                                     to hear from you. See the instructions for your income tax return. 

                                                                           Cat. No. 11712F                                             Form 2120 (Rev. 10-2018) 






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