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OMB No. 1545-1620
Form
1040
Additional Child Tax Credit
. . . . . . . . . .
2004
8812
U -GU
1040A
8812
Attachment
Department of
47
Complete and attach to Form 1040 or Form 1040A.
Sequence No.
Revenue and Taxation
Name(s) shown on return
Your social security number
Part I
All Filers
1
Enter the amount from line 1 of your Child Tax Credit Worksheet on page 38 of the Form 1040 instructions
or page 37 of the Form 1040A instructions. If you used Pub. 972, enter the amount from line 8 of the
1
worksheet on page 4 of the publication
2
2
Enter the amount from Form 1040, line 51, or Form 1040A, line 33
3
3
Subtract line 2 from line 1. If zero, stop; you cannot take this credit
4a
4a
Enter your total earned income. See the instructions on back
4b
b
Nontaxable combat pay included on line 4a
5
Is the amount on line 4a more than $10,750?
No.
Leave line 5 blank and enter -0- on line 6.
5
Yes. Subtract $10,750 from the amount on line 4a. Enter the result
6
6
Multiply the amount on line 5 by 15% (.15) and enter the result
Next. Do you have three or more qualifying children?
No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the
smaller of line 3 or line 6 on line 13.
Yes.
If line 6 is equal to or more than line 3, skip Part II and enter the amount from line 3 on
line 13. Otherwise, go to line 7.
Part II
Certain Filers Who Have Three or More Qualifying Children
7
Enter the total of the withheld social security and Medicare taxes from Form(s)
W-2, boxes 4 and 6. If married filing jointly, include your spouse’s amounts
7
with yours. If you worked for a railroad, see the instructions on back
8
1040 filers:
Enter the total of the amounts from Form 1040, lines
30 and 58, plus any uncollected social security and
8
Medicare or tier 1 RRTA taxes included on line 62.
1040A filers:
Enter -0-.
9
9
Add lines 7 and 8
10
1040 filers:
Enter the total of the amounts from Form 1040, lines
65a and 66.
1040A filers:
Enter the total of the amount from Form 1040A, line
10
41a, plus any excess social security and tier 1 RRTA
taxes withheld that you entered to the left of line 43
(see the instructions on back).
11
11
Subtract line 10 from line 9. If zero or less, enter -0-
12
12
Enter the larger of line 6 or line 11 here
Next, enter the smaller of line 3 or line 12 on line 13.
Your Additional Child Tax Credit
Part III
13
This is your additional child tax credit
13
Enter this amount on
Form 1040, line 67, or
Form 1040A, line 42.
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For Paperwork Reduction Act Notice, see back of form.
Cat. No. 10644E
Form 8812-GU (2004)