Annual Child Care Income Report (W-10)
Annual Child Care Income Report (W-10)
Provided here is a report of the annual amount paid to me for Child Care services provided for:
______________________________________________________________
First Last DOB
______________________________________________________________
First Last DOB
My records show that a total of $__________ for the year _________ was paid to me by one or both of the following:
_____________________________________________
First Last
_____________________________________________
First Last
The above total yearly amount was paid to:
Provider Name
Business Name
Address
Address
SSN or EIN
You will need to sign and date this form and return one copy to me and keep one for your records. It is important to me that the amount we both report to the IRS match.
If you find that your records indicate a different amount, please notify me of the discrepancy
Parent Signature _____________________________ Date ____________
Parent Signature _____________________________ Date ____________
Provider Signature ____________________________ Date ____________
................
................
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