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Over 65 1e X 1f XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 2b 999-99-9999 2c X 2d X 2e X 2f X 46 47 48 49 (You must report the first 5 dependents in the table below and additional dependents on Schedule PIT-S) Column 1. Last name Column 2. Dependent's SSN XXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXX 999-99-9999 999-99-9999 999-99-9999 999-99-9999 999-99-9999 56 57 58 59 60 61 62 63 2 64 4 MM/DD/CCYY Column 3. D.

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