Form Ftb 4803e - Head Of Household Schedule - 2004 printable pdf download

Form Ftb 4803e - Head Of Household Schedule - 2004

2004 Head of Household Schedule (4803e)

1. Look at the chart below to identify the relationship of the person you believe qualified you for the head

of household filing status. Enter the code number for that relationship in the code box to the right.

Relationship

Code

Son, daughter, stepson, or stepdaughter

Grandchild

Foster child

Father or mother

Brother, sister, stepbrother, stepsister, half-brother, half-sister,

Code

grandfather, grandmother, stepfather, stepmother; son-in-law,

daughter-in-law, father-in-law, mother-in-law, brother-in-law, or

sister-in-law

Uncle, aunt, nephew, or niece

Other (please explain) _______________________________

(You cannot claim yourself, your spouse, or your tax preparer.)

2. Provide the social security number, name, and age of the qualifying person you indicated in question 1.

Social Security Number:

Name: ___________________________

Age in years as of 12/31/2004:

If less than one year old, age in months:

3. Were you entitled to claim a dependent exemption credit for your qualifying person in 2004?

Yes.

No.

4. Did the qualifying person live with you the entire year in 2004?

Yes. Go to Question 6.

No. List the beginning and ending dates of each period the qualifying

person lived with you during 2004, or provide the total number of

days the qualifying person lived with you during 2004 and answer question 5.

From

Total number of days

(More than 12 hours each day)

From

FTB 4803e 2004

Page

Form Ftb 4803e - Head Of Household Schedule - 2004