English
Maintenance Declaration for Calendar Year 20
Mr./Ms. First name Surname
Residing in Street Postcode City
Germany
has requested that maintenance payments to the following person be approved for tax deduction:
Supported person
A. Personal details
First name and surname
Date of birth
Place of birth
City
Familial relationship to
Applicant/Spouse
Family status
Single Married Widowed Divorced
(please cross as applicable)
Job (please enter or cross Type of work Regular Occasional None
as applicable)
Other persons living in the
household
Confirmation of foreign municipal authority/registration office:
The preceding information on the person to be supported is in accordance with the truth, according to our
documents.
Official seal and signature
(place, date)
034401/1 English Maintenance Declaration
(05/2009)
B. Economic status of the person to be supported
I. Income/outgoings
As the person to be supported, I had the following income and outgoings in the year 20 :
consisting of Income (in national currency) Outgoings (in national currency)
Salary
Annuity/pension
Agriculture
Trade activity/
freelance activity
Letting/leasing
Other sources of income
(e.g. interest etc.)
Social benefits
Note:
The aforementioned statements are to be proven, e.g. by the following documents: Tax
statement, pension approval certificate, certificate from the responsible labour or social authorities
on the social benefits received from the state (or, if you do not receive any, a clearance certificate
from the authorities stating this)
II. Assets
As the person to be supported, I had the following assets in the year 20 :
Type of asset Explanation Value in national currency
Total value of assets
Of which:
Estate:
Own house
Agriculture
Further holdings
Other assets
(e.g. bank deposit,
insurance policies)
My assets are sufficient to meet subsistence costs: Yes No
(please cross as applicable)
034401/2 English Maintenance Declaration
(05/2009)
C. Other information
1. When did you first receive support? Month Year
2. How were you paid and who
made the payments?
(Please explain)
3. How did you meet your living
costs before the support
payments began?
(Please explain)
4. a) Do you live together in a household with other supported persons? Yes No
(please cross as applicable)
4. b) If yes, please state their
names and their
relationship to you.
5. a) Do other people contribute subsistence money? Yes No
(please cross as applicable)
5. b) If yes, please give the name
and address of this/these
person(s) and the amount of
support they provide.
6. Why were you
unemployed/only
occasionally employed?
(Please explain if applicable -
this only needs to be filled out
if you are of working age)
034401/3 English Maintenance Declaration
(05/2009)
D. Guarantee
I guarantee that the above information is true and has been declared to the best of my knowledge and in good
faith.
(Place, date) (Signature of the person receiving support)
Note:
The information on the supported person are considered to be information on the person liable for tax.
Incorrect information may lead to fines or legal penalties.
E. Explanations
1. For each supported person, one certificate must be issued and submitted as a document for
the income tax return.
2. Submission of the certificate does not entitle the submitter to any legal right to the tax allowance that has
been applied for. The fiscal authorities may, in individual cases, demand further proof.
034401/4 English Maintenance Declaration
(05/2009)
