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# of people claimed on taxes17698100187118721873187418751876187718781879188018811882188318841885188618871888188918901891189218931894189518961897189818991900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050205120522053205420552056205720582059206020612062206320642065206620672068206920702071207220732074207520762077207820792080208120822083208420852086208720882089209020912092209320942095209620972098209921002101210221032104210521062107210821092110211121122113211421152116211721182119212021212122212321242125212621272128212921302131213221332134213521362137213821392140214121422143214421452146214721482149215021512152215321542155215621572158215921602161216221632164216521662167216821692170217121722173217421752176217721782179218021812182218321842185218621872188218921902191219221932194219521962197219821992200220122022203220422052206220722082209221022112212221322142215221622172218221922202221222222232345
# People Need Coverage13+2345
Income SourceJobSelf EmployedSocial SecurityUnemployment CompensationCurrently UnemployedDisabilityRetired
Employer Name
Projected Household Monthly $
Spouse First Name
Spouse Last Name
Spouse Date of Birth
Spouse SS #
Spouse Income SourceJobSelf EmployedSocial SecurityUnemployment CompensationCurrently UnemployedDisabilityRetired
Spouse Getting CoverageYesNo
Child #1 First Name
Child #1 Last Name
Child #1 Date of Birth
Child #1 SS#
Is Child #1 getting coverage?YesNo
Child #1 RelationshipSonBoyfriendFianceHusbandSister SpouseWife Mom0Myself NaNoneSpouceParejanoSpoussGirlfriend for 27 yrs.SelfFianceeSpousrgirlfriend EsposoN/aDaugherPartner Mother 48900step daughterGranddaughter full guardianshipChildGranddaughter Twin sister Fience’SpoudeFatherSpoysedomestic partnersisters DaughtetSignificant other SpouBoy friendGrand daughterSpouesSpousNephewGrandsonFiancé FriendBrotherHusband/ wifeSpouse 5 SpouseGrandaonSouseSenifigant Freind5Son/Mother Gril friend FeinceBoyfriend 5FiancéeSpousesCommon law spouseLife partnerMe significant otherFMateSppuseNiece Spouse5Spouaedomestic parternSpouedaughter 5Spousal StepsonSpoiseSpouse/HusbandSomSignificance otherGirl friendExGrandmotherSpiuseBetter hafe Wife2Not relatedDaughteeStep fatherDaugtherCynthiaSinFinanceFaughter5Sister by marriageGirlfriend/fianceSposespousdCommon-law husband Spouse husbandHisbandDomestic partnersDemented daughterSiblings SiblingStep son254838970Room mateWwwwsssHubband SonaFrie dWife 55Husband 5Signficant otherDaughter5Spouse(wife).sonHubsandSignifice otherCommon lawSpous3Spouse My husbandDsughterFiancéeOld bastardBaby boy baby girl baby girlDemistic partnerLifw partnerIComon law wifeHusband5ex husband Spouse6Spouse/partner Daughter35SpouseFia`nceHusband/Grand doughterSpouse 55?long time companion Wife’sBoyfryBo3yfriendMarriedBoyfriend fiancé DauhhterWigeUncle Commenlaw husband Friends Live in Granddoughter HusbandSOOUSEsister in LawHusband 2CompanionSon’s girlfriendFreindSpounsSistrrGrandchild 2FiniceLegal guardian/grandmotherSppiseStep dadDaughter in lawGetting married in 2 yrs after grafuateNeice Soon to be husbandDpouseComing law marriedLegal Guardian Husband’s Ex spouseSpouse that has her on insurance Dadwife1Not applicable SpousaNo oneBiyfriendSpouce1StepdaughterDayghterDomestic partnershipRoommateHusbanfSpoucParentHead PartnerTwinDaaughter?pouseGetting married Conyugemy wifeCommon law husband Comma law husband Live in partnerNooneDaugterspouse wifeMelvina Jolmes. HusbandFinaceHave insuranceScientific otherGrilfrendspousespouse fiancesignificate otherSon byStepmather117787331SpouySoLinux armv8lLinux armv7liPhoneWin32Linux aarch64Linux x86_64Friend/boarderMotgerWish he was daddysignificant Fiance’Disabled sonWife/spouseGrand sonStepfather Husband 1ROOMATEhis mothergrandaughtermother in lawNo relation. WifenoneFuqboifiance’eDaughteSignificant otheeSpouse 1SpuseSpouse qMohherBoyfriemdCommon law marriage SonGranddaughters FinancaWife two sons one daughterFiance / Life PartnerChildren FatherApouswMamaHijoWife2Son 5FaughterJust meDaughter/ ChildLive with me GranddaugtherAamya SmithSpouseDeontyaHijaSpouswFiance’SlouseGuardianConyugueDomistic partnerGirlfiendSponceDomestic partner0JohnGod childDaughtsrSpouseTariqDaughterlZpouseSpouse (has own insurance)Spou6JamieDaugjterSpouce5ApouseSignificant other (fiance)NesiceFiance/ domestic partnerCousinFathetSponse NoneHousman SknSoon to be spouse GfChild/sonHusbon EngagedFienceSpouse/friendsKidSpouseâ¹Ã¼pFinaceeSpouzsFieanceSelboyfriend of 15 yearsHusbandSSell Boyfriends Mother PartberSpouse wifeLife partenerFilhoOPaula jacobsDaughemrSelpMamáDautherLegal guardian/SisterHijastroSeflfStep kidDauggtee/////BuddyDaughter 2His momGreat niece SobCommon law husbandGrandpa SpiceDaughtWhifeStep brother 2nd person is on disability and had medicareLive withNobody ElseSame NSame0HushandN A NotSaneCompamionQueen queen size queen queen HubandSpouse petcBoyfreindFiancaChildrenNewfew Love Father of soon to be born childSame person Half SiblingMyselfeNothingCommon law wifeChristine escobar/DaighterSingleBaby Mother Fiance/ Children’s father PersonhubdandGrandchildren OooSons fatherSpaDemestic PartnerFiance’s benefits for usGoodDaughter 0erSon in schoolStep- DaughterMadre patientspouse1Fils DaughtrtMy Son Little sisterSoñSchoolShe is my motherMORTHER My daughter Signate otherBaby dadSPOUSE ( WIFE)Only meGrandma 158771740Cousin what’s playing choice well my social securityCare giver SpoceDaughtweSiblings her brotherSpounce05/22/21111/22 Brother PartenterYes cónyuge Baby’s fatherDisowjcbsnsnNo relation Baby SupposeChild’s motherGrandson/guardian ofCompianionSon has medicaidSignafant otherN?AStep-dad dfgSpouse to Same as aboveSpouse/Significant other 343MOTHER/SONMon mari FamilySignl fainceMy Officer I.D.aelfN /AStepmother Matthew BrookinsNomeGreat grandsonN.ADaghter N/AMy Mother Twin Daughter Spouseâ´Daughters fatherit’s me just said I had to fill this out SposesGrand childDaughter covetedSpouse has medicare Siblingguy friendBest friendHusband said Spouse7Spouse Tillman My self Adopted Son No Delf490948634Brother in lawYoDomestic Patner YrrrgffRoom madeIt’s meFamily friendSPAUSEthanksNpA/nMy Child Son/daughter Better halfEsposaDaughterGrandchildniece/nephewother
Child #2 First Name
Child #2 Last Name
Child #2 Date of Birth
Child #2 SS#
Is Child #2 getting coverage?yesno
Child #2 RelationshipsonFiance SelfgranddaughterBoyfriendDaugterDaughter in lawBrotherSinsisterNoneMeGeandsonFather0DadSon in lawSGrandsonSpouse NeiceHusband Childstep sonSomN/ASignificant otherI am her legal guardianCynthia Stepdaughter NStepsonGrand daughter Step DaughterBrother in lawNACousinGod childGrandson/sonNephewFriendOFuture step-sonBaby boy baby girl baby girlMarriedBrorherStep-daugter UncleMotherSo S9m629903793Legal guardian/ grandmotherDaugtherWifeDaughtetDaighterDaughteePartnerNot applicable DaughtterHeadnieceMyselfStep childNo KidDaughters boyfriendNoonedaughyHalf-brother Grandmother SposeMy son Sister in lawFrSteptdaughterEx spouseHubsandDomestic PartnerFuqboiSoonDaughter 5SpousdaughgerSiblingPartners sonJust meDaughter/ Child Grand childgraddaughterMom/SonChild sonstepchildDaughter5Fiancé Grsat nephew—legal custodyHijoNomeDaughters/man ….Dougther AuntMother-in-law momConjugueSo nFianceeStep sinHermanaDuaterFaughterDaughtherHijastroStep kidpartners childrenDoughter Just Me JoAnn DavisParent 5Same Step daugtherOooooNo one DaugherRoomateMother in lawDaughter-in-law HusandN ANotSpousrN/No 3rdQueen queen size queen queen bed queen Not apply NothingI’m her MothergranddaugtherFiancée /SingleDjsPersonGrandchildrenKkkkNobeNonÑ/ASelf its just meSame person HijaGirlfriend Step-father SisrerDotherByNonoefdgtwin sisterSame as aboveNobodywqeweBXhusbandSon.MOTHER/SONDParentEnfantNondMy selfDaughqRoommatePpppppStep brotherNmpretendooNoone else SelfMy husbandNjjxhxhWiDaughyerLittle sisterEtc NaStep daddauhterGreat grandson Girl firendN.AFinanceNeitherTwin Daughterhalf sisterKenneth WilsonGrandmaGranddaughter I got custody threw courtAdopted SonStepfatherKenneth SnowNone 0It’s meStep so YoStep sisterEx husband VgffgvDouhhterIt’s me0â°0SonqSpouceNonrthanksNpGrandbaby unknowndaughtergrandchildniece/nephewother
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