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|00000000| 00 80 d0 41 52 54 20 c9 | c9 2e 20 c3 48 49 4c 44 |...ART .|.. .HILD|
|00000010| 20 c3 41 52 45 20 c3 52 | 45 44 49 54 20 28 32 2d | .ARE .R|EDIT (2-|
|00000020| 38 29 0d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |8).-----|--------|
|00000030| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000040| 2d 2d 2d 0d 0d 31 3a 20 | d3 45 4c 45 43 54 20 59 |---..1: |.ELECT Y|
|00000050| 4f 55 52 20 46 49 4c 49 | 4e 47 20 53 54 41 54 55 |OUR FILI|NG STATU|
|00000060| 53 20 2d 2d 0d 4d 41 52 | 52 49 45 44 20 46 49 4c |S --.MAR|RIED FIL|
|00000070| 49 4e 47 20 4a 4f 49 4e | 54 4c 59 20 4f 52 20 4f |ING JOIN|TLY OR O|
|00000080| 54 48 45 52 20 28 48 45 | 41 44 0d 4f 46 20 48 4f |THER (HE|AD.OF HO|
|00000090| 55 53 45 48 4f 4c 44 2c | 20 53 49 4e 47 4c 45 20 |USEHOLD,| SINGLE |
|000000a0| 57 49 54 48 20 44 45 50 | 45 4e 44 45 4e 54 29 0d |WITH DEP|ENDENT).|
|000000b0| 2d 2d 20 42 59 20 50 52 | 45 53 53 49 4e 47 20 d2 |-- BY PR|ESSING .|
|000000c0| c5 d4 d5 d2 ce 2e 0d 0d | 32 3a 20 c5 4e 54 45 52 |........|2: .NTER|
|000000d0| 20 54 48 45 20 41 4d 4f | 55 4e 54 20 4f 46 20 43 | THE AMO|UNT OF C|
|000000e0| 48 49 4c 44 20 43 41 52 | 45 0d 45 58 50 45 4e 53 |HILD CAR|E.EXPENS|
|000000f0| 45 53 20 54 48 41 54 20 | 59 4f 55 20 49 4e 43 55 |ES THAT |YOU INCU|
|00000100| 52 52 45 44 2e 0d 0d 33 | 3a 20 c5 4e 54 45 52 20 |RRED...3|: .NTER |
|00000110| 54 48 45 20 4e 55 4d 42 | 45 52 20 4f 46 20 51 55 |THE NUMB|ER OF QU|
|00000120| 41 4c 49 46 59 49 4e 47 | 0d 50 45 52 53 4f 4e 53 |ALIFYING|.PERSONS|
|00000130| 20 54 48 41 54 20 57 45 | 52 45 20 43 41 52 45 44 | THAT WE|RE CARED|
|00000140| 20 46 4f 52 20 49 4e 20 | 31 39 39 31 2e 0d 0d 34 | FOR IN |1991...4|
|00000150| 3a 20 c5 4e 54 45 52 20 | 54 48 45 20 41 4d 4f 55 |: .NTER |THE AMOU|
|00000160| 4e 54 20 4f 46 20 51 55 | 41 4c 49 46 49 45 44 0d |NT OF QU|ALIFIED.|
|00000170| 45 58 50 45 4e 53 45 53 | 20 59 4f 55 20 49 4e 43 |EXPENSES| YOU INC|
|00000180| 55 52 52 45 44 20 41 4e | 44 20 50 41 49 44 20 49 |URRED AN|D PAID I|
|00000190| 4e 0d 31 39 39 31 2e 0d | 0d 0d 0d 35 3a 20 d4 48 |N.1991..|...5: .H|
|000001a0| 49 53 20 49 53 20 24 32 | 34 30 30 20 28 24 34 38 |IS IS $2|400 ($48|
|000001b0| 30 30 20 49 46 20 54 57 | 4f 20 4f 52 0d 4d 4f 52 |00 IF TW|O OR.MOR|
|000001c0| 45 20 43 48 49 4c 44 52 | 45 4e 29 2e 0d 0d 36 3a |E CHILDR|EN)...6:|
|000001d0| 20 c5 58 43 4c 55 44 45 | 44 20 42 45 4e 45 46 49 | .XCLUDE|D BENEFI|
|000001e0| 54 53 20 46 52 4f 4d 20 | 4c 49 4e 45 20 32 35 2c |TS FROM |LINE 25,|
|000001f0| 0d d0 41 52 54 20 c9 c9 | c9 2e 20 20 c9 46 20 59 |..ART ..|..  .F Y|
|00000200| 4f 55 20 48 41 56 45 20 | 45 4d 50 4c 4f 59 45 52 |OU HAVE |EMPLOYER|
|00000210| 2d 0d 50 52 4f 56 49 44 | 45 44 20 44 45 50 45 4e |-.PROVID|ED DEPEN|
|00000220| 44 45 4e 54 20 43 41 52 | 45 20 42 45 4e 45 46 49 |DENT CAR|E BENEFI|
|00000230| 54 53 2c 20 42 45 0d 53 | 55 52 45 20 54 4f 20 43 |TS, BE.S|URE TO C|
|00000240| 4f 4d 50 4c 45 54 45 20 | d0 41 52 54 20 c9 c9 c9 |OMPLETE |.ART ...|
|00000250| 2e 0d 0d 37 3a 20 cc 49 | 4e 45 20 35 20 2d 20 4c |...7: .I|NE 5 - L|
|00000260| 49 4e 45 20 36 2e 0d 0d | 38 3a 20 d4 48 45 20 53 |INE 6...|8: .HE S|
|00000270| 4d 41 4c 4c 45 52 20 4f | 46 20 4c 49 4e 45 53 20 |MALLER O|F LINES |
|00000280| 34 20 41 4e 44 20 37 2e | 0d                      |4 AND 7.|.       |
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