Daycare Tax Statement Template

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Daycare Tax Statement
I, ___________________________________________________, received the following amount in cash, check or
money order between January 1st and December 31st in the year _____________________.
Total amount received: ____________________________________________
Received from (Name and Address):_______________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Parent Signature: ________________________________________________________________________________
Provider Signature: ______________________________________________________________________________
Daycare Tax Statement
I, ___________________________________________________, received the following amount in cash, check or
money order between January 1st and December 31st in the year _____________________.
Total amount received: ____________________________________________
Received from (Name and Address): _______________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Parent Signature: _________________________________________________________________________________
Provider Signature: _______________________________________________________________________________

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