AGREEMENT made [date] by and between [name], residing at [address], [name], residing at [address], and [name], residing at [address].
WHEREAS, each of the parties is a child [or, a niece or nephew; or, an aunt or uncle; or, a child or grandchild] of [name] (Dependent) who resides at [address]; and
WHEREAS, Dependent has earned income of less than the exemption amount described in Section 151(c)(1)(9A) of the Internal Revenue Code; and
WHEREAS, the parties wish to provide more than half of Dependent's support and also wish to allocate to [name] (Administrator) the right to claim the dependency exemption for Dependent for federal and state income tax purposes;
NOW, THEREFORE, in consideration of the mutual promises contained herein and other good and valuable consideration.
IT IS AGREED between the parties as follows:
1. Parties' Contributions. Each of the parties hereto will contribute the sum of ---------- dollars ($----------) monthly to be used entirely for the support of Dependent. It is the intent of the parties that such combined contributions shall constitute more than one half of Dependent's support.
2. When Contributions Will Be Made. The aforesaid monthly contributions shall be made no later than the [number] day of each month commencing with the month of [month and year]. Each contribution will be made by check payable to "[name of Administrator] in trust for [name of Dependent]."
3. Separate Checking Account for Contributions. Administrator will open a checking account at a bank of Administrator's own choosing located in [city] in the name of "[name of Administrator] in trust for [name of Dependent]" and will deposit in that account the sums received by Administrator from [name] and [name] pursuant to this Agreement together with the monthly contribution required of Administrator hereunder.
4. Disbursement of Contributions. Administrator will disburse from said account all sums needed for Dependent's support. Administrator will keep accurate records of such disbursements and, upon request, will permit [name] and/or [name] to examine the records, including bank statements and canceled checks.
5. Release of Claim for Dependency Exemption by Contributors in Favor of Administrator. [Name] and [name] represent that neither of them will claim Dependent as a dependent on any federal or state income tax return that either of them files. [Name] and [name] each releases his or her right to claim Dependent as a dependent for federal and income tax purposes in favor of Administrator. In furtherance of the aforesaid representation and release, [name] and [name] will annually execute Internal Revenue Service Form 2120 (Multiple Support Declaration) in favor of Administrator and will deliver the same to Administrator so that Administrator may attach it to Administrator's federal income tax return for said year.
6. Termination of Agreement. This Agreement will terminate upon the death of Dependent, or of any of the parties hereto. If this Agreement terminates because of Dependent's death, any sums remaining in the checking account descried in Paragraph 3 shall be equally distributed among the parties hereto. If this Agreement terminates because of the death of one of the parties hereto, any sums remaining in the checking account shall be applied to Dependent's support, and the surviving parties will enter into a new agreement for Dependent's support.
IN WITNESS WHEREOF, the parties have signed this Agreement the day and year first above written.
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