May 29th, 2015
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FormOMB No. 1545-0074Child and Dependent Care Expenses24412010Attach to Form 1040, Form 1040A, or Form 1040NRDepartment of the TreasuryInternal Revenue Service (99)AttachmentSequence No.See separate instructions.Name(s) shown on returnHaroldPart IPetersanand SarahPetersan011-01-1000Persons or Organizations Who Provided the Care - You must complete this part.(If you have more than two care providers, see the instructions.)(a) Care provider'sname121Your social security number(b) Address(number, street, apt. no., city, state, and ZIP code)(c) Identify

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