Form 502B Fillable Maryland Dependents Information
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

65 or over 65 or over 65 or over 65 or over 65 or over (: no) Unchecked (: No) Unchecked (: No) Unchecked (: Yes) Unchecked (: Yes) Unchecked (: Yes) Unchecked (Attach to Form 502 505 or 515 ) (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (For Form 502 resident taxpayers only ) (For Form 502 resident taxpayers only ) (For Form 502 resident taxpayers only ) (For Form 502 resident taxpayers only ) (For Form 502 resident taxpayers only ) (Initial) (Last name) (Last name) (no: 2) Unchecked (no: 2) Unchecked (no: No) Unchecked (no: Yes) Unchecked (no: Yes) Unchecked (Social Security number) (Spouse s first name) (Spouse's Social Security number) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (Your first name) 1 Enter the total number of boxes checked below for Regular dependents (6) 1 First name Initial Last name 1 First name Initial Last name 1 First name Initial Last name 1 First name Initial Last name 1 First name Initial Last name 2 Enter the total number of additional boxes checked below for dependents 65 or over (7) 2 Social Security Number 3 Relationship 2 Social Security Number 3 Relationship 2 Social Security Number 3 Relationship 2 Social Security Number 3 Relationship 2 Social Security Number 3 Relationship 3 Total dependent exemptions (Add lines 1 and 2 and enter the total here and on line (C) of the 5 Has medical insurance? Yes 5 Has medical insurance? Yes 5 Has medical insurance? Yes 5 Has medical insurance? Yes 5 Has medical insurance? Yes 502B (Attach to Form 502 505 or 515 ) Attachment COM/RAD 026 13 49 Dependents Dependents (If a dependent listed below is age 65 or over please check both boxes 6 and 7 ) Exemptions area of Form 502 505 or 515 ) 3 if under 19 if under 19 if under 19 if under 19 if under 19 Initial Last name MARYLAND Dependents' Information NAME SSN No 06 Page 2 Print UsingBlue or Black Ink Regular 7 Regular 7 Regular 7 Regular 7 Regular 7 Sequence Social Security Number Spouse s first name Spouse's Social Security Number Summary Your first name