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 each of them successively 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. Revolving Dependency Exemption. The parties agree that each of them shall claim Dependent as a dependent on each party's federal and state income tax returns successively, and the parties release to each other the right to do so. [Name] shall claim the dependency exemption for the first year in which this Agreement is in effect, [name] for the second year, and [name] for the third year. Thereafter, the parties will claim the dependency exemption in successive years in the same order until this Agreement terminates. In each year, the nonclaiming parties will execute Internal Revenue Service Form 2120 (Multiple Support Agreement) in favor of the claiming party and will deliver the same to said party so that the claiming party may attach it to said party's federal income tax return for such 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 described 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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