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If you have more than two care providers see the instructions. a Care provider s name b Address number street apt* no* city state and ZIP code c Identifying number SSN or EIN d Amount paid see instructions Complete only Part II below. Did you receive No dependent care benefits Complete Part III on the back next. Yes Caution* If the care was provided in your home you may owe employment taxes. If you do you cannot file Form 1040A. For details see the instructions for Form 1040 line 59 or Form 104 ...

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