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Sample Template for Use by Childcare Providers

***Ask your primary childcare provider to copy the template below to its letterhead and input the needed information to replace the guidelines in the brackets < > and the brackets ***

 

<Insert Today's Date>

<Insert Parent/Guardian’s Name and Address>


Re: <Insert Child's Name>

To Whom It May Concern:

Our records show we provided service(s) to <Child's Name> at <Name of Care Provider> on the following date(s) <Insert the Date(s) You Provided Service(s) for the Tax Year On the Notice>.

Our records reflect that the child lived at <Street Address, City, State,
Zip Code (if the child moved during the year show all addresses)>
during this time. Our records also reflect that the child’s parent or guardian during this time was <Insert Parent's or Guardian’s Name(s)>. The child’s parent's or guardian's address of record during this time was listed as <Insert Parent's or Guardian’s Address(es)>.

Sincerely,

<Insert Signature of School/Day Care Official>
<Insert Title of School/Day Care Official>
<Insert Phone Number of School/Day Care Official>

Page Last Reviewed or Updated: 06-Apr-2017