Personal Information Worksheet 2017 I. Keep for your records QuickZoom to another copy of Personal Information Worksheet QuickZoom to Federal Information Worksheet Part I - First name. • • Suffix Social security no. . . Member of U.S. Armed Forces in 2017?=I— I Yes Date of birth (mm/ddiyyyy) Occupation . . . . Marital status . • • If widowed, check the appropriate box for the year yours pouse died: After 2017 im•r- 1 2017 . 2016 . 01 I 2015 . Are you retired on total and permanent disability? (for Schedule R, see Help). I. Yes No If deceased, enter the date of death ► (mmidd/yyyy) Were you under the age of 16 as of 1-1-2018 and this is the first year you are filing a tax return? Do you want $3 to go to Presidential Election Campaign Fund? Middle initial . Last name • • No age as of 1-1-2018 Daytime phone. • • • Ext Check if this person is legally blind Before 2015 . P.M .9 Yes No Yes I- I No CI Yes C No Part II — Questions for Individuals Who Could Be Or Are Dependents of Another Taxpayer 1 Can someone (such as your parent) claim you as a dependent? Yes No 2 If you answered 'Yes' to question 1, are you actually claimed as a dependent on that person's tax return? -0 Yes 140 Questions 3 through 5 are only required for individuals who claim the American Opportunity Credit. 3 Were you a full-time student during any part of five months during 2017? ► Yes No 4 Did your earned income exceed one-half of your support? ► Yes No 5 Was at least one of your parents alive on December 31, 2017? ► Yes No Part III — Enter this person's state of residence as of December 31, 2017 Check the appropriate box: This person is a resident of the state above for the entire year This person is a resident of the state above for only part of year Date this person established residence in state above ► In which state (or foreign country) did this person reside before this change? Part