I (We) _____________________________________________________, parents/guardians of
Name of parents/guardians
_________________________________________, declare that I (we) will not claim our Name of son/daughter/dependent
son/daughter/dependent noted above as a dependent on my (our) Federal income tax
return this year or in future years while our son/daughter is a resident of Florida
and while I (we) remain non-residents of Florida.
_________________________________ _________________________________
Signature of parent/guardian
Signature of parent/guardian
_________________________________ _________________________________
Date
Date
________________________________________________________________________
Address of parent/guardian
State of ________________, County of ______________________________
The foregoing instrument was acknowledged before me this ________________ by
________________________________________________ who is personally known to me or
who has produced _______________________________________ as identification.
