2015 Organizer 33.1, 33.2 - Child & Dependent Care Expenses

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ORGANIZER
2015
1040
US
Child and Dependent Care Expenses (Form 2441)
33.1,33.2
Please enter all pertinent 2015 information. Last year's amounts are provided for your reference. You must have
paid for the care of one or more dependents enabling you to work or attend school to qualify for this credit.
2015 Amount
2014 Amount
DEPENDENT CARE EXPENSES (33.1)
Taxpayer
Spouse
Taxpayer
Spouse
Dependent care expenses incurred but not paid in 2015
. . .
Employer-provided benefits forfeited in 2015
. . . . . . . . . . . . . .
PERSONS AND EXPENSES QUALIFYING FOR DEPENDENT CARE CREDIT
First name
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Last name
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Title or suffix
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date of birth (m/d/y)
. . . . . . . . . . . . . . . . . . . . . .
No.
Social security number
. . . . . . . . . . . . . . . . . . . .
Qualified dependent care expenses
incurred and paid in 2015
2014 amt:
. . . . . . . . . . . . . . . . .
1=disabled
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1=spouse, 2=joint
. . . . . . . . . . . . . . . . . . . . . . . .
First name
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Last name
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Title or suffix
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date of birth (m/d/y)
. . . . . . . . . . . . . . . . . . . . . .
No.
Social security number
. . . . . . . . . . . . . . . . . . . .
Qualified dependent care expenses
incurred and paid in 2015
2014 amt:
. . . . . . . . . . . . . . . . .
1=disabled
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1=spouse, 2=joint
. . . . . . . . . . . . . . . . . . . . . . . .
PERSONS OR ORGANIZATIONS PROVIDING CARE (33.2)
Name of provider
. . . . . . . . . . . . . . . . . . . . . . . . .
Street address
. . . . . . . . . . . . . . . . . . . . . . . . . . .
City
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
State
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ZIP code
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No.
Foreign region
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Foreign postal code
. . . . . . . . . . . . . . . . . . . . . . .
Foreign country
. . . . . . . . . . . . . . . . . . . . . . . . . .
Identification number (SSN or EIN)
. . . . . . . .
Amount paid to care provider in 2015
2014 amt:
. . . . . .
1=spouse, 2=joint
. . . . . . . . . . . . . . . . . . . . . . . .
33.1,33.2
Child and Dependent Care Expenses (Form 2441)
Series: 31, 34

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