Form W-10, Dependent Care Provider’s Identification Completed Form Examples and Samples
Explore a detailed example of a completed IRS Form W-10 tailored for in-home child care providers. This guide includes step-by-step instructions for filling out the form with essential details like legal name, business address, and tax identification information.
W-10 Example – In-Home Child Care Provider
How this form was filled:
The form displays the provider's details including legal name, business name, address, and tax identification number. The example demonstrates the correct completion of these fields for a provider offering in-home child care services.
Information used to fill out the document:
- Legal Name: Jessica Smith
- Business Name: Jessica's Tiny Tots Care
- Mailing Address: 456 Maple Avenue, Springfield, USA
- Social Security Number (SSN): 123-45-6789
- Provider's Signature: Jessica Smith
- Date: 01/20/2025
What this filled form sample shows:
- Accurate legal name and business name entries
- Proper SSN format
- Correctly filled address for reliable contact
- Properly formatted signature and date
Form specifications and details:
| Use Case: | In-home child care provider |
