Form 2441n - Nebraska Child And Dependent Care Expenses
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Nebraska Child and Dependent Care Expenses
FORM 2441N
• File Form 2441N ONLY if you do not file Federal Form 2441 or Form 1040A, Schedule 2
2007
• File only if your federal adjusted gross income is $29,000 or less
• Complete reverse side if receiving dependent benefits care
• Attach to Form 1040N
Name as Shown on Form 1040N
Your Social Security Number
BEFORE YOU BEGIN: You need to understand the following terms. See Federal Form 2441 Definitions on page 1 of
those instructions.
• Dependent Care Benefits
• Qualifying Person(s)
• Qualified Expenses
PART I — Persons or Organizations Who Provide the Care
• You must complete this part. (If you need more space, use the bottom of page 2.)
1
(A)
(B)
(C)
(D)
Care
Address
Identifying Number
Amount paid
Provider’s Name
(Number, Street, Apt. No., City, State, and Zip Code)
(SSN or EIN)
(See Instructions)
No
Complete only Part II below.
Did you receive
dependent care benefits?
Yes
Complete Part III on the back next.
CAUTION: If the care was provided in your home, you may owe employment taxes. See the instructions for Federal Form 1040, line 62.
PART II — Credit for Child and Dependent Care Expenses
2 Information about your qualifying person(s). If you have more than three qualifying persons, attach a schedule.
(A)
(B)
(C) Qualified Expenses You
Qualifying Person’s Name
Qualifying Person’s
Incurred and Paid in 2007 for the
First
Last
Social Security Number
person(s) listed in Column (A)
3 Add the amounts in Column (C) of line 2. Do not enter more than $3,000 for one qualifying
person or $6,000 for two or more persons. If you completed Part III, enter the amount from
line 30 ................................................................................................................................................
3
4 Enter your earned income. See Federal Form 2441 instructions .....................................................
4
5 If married filing jointly, enter your spouse’s earned income (if your spouse was a student or was
disabled, see the Federal Form 2441 instructions); all others, enter the amount from line 4 ...........
5
6 Enter the smallest of line 3, 4, or 5 ...................................................................................................
6
7 Enter the amount from Form 1040N line 5 or Form 1040NS line 3
(If line 7 is over $29,000, do not file this form) ............................................. 7
8 Enter on line 8 the decimal amount shown below that applies to the amount on line 7
If line 7 is:
But not
Federal decimal
Over
over
amount is
$0
–
15,000
.35
15,000
–
17,000
.34
17,000
–
19,000
.33
19,000
–
21,000
.32
21,000
–
23,000
.31
23,000
–
25,000
.30
25,000
–
27,000
.29
8
x .
27,000
–
29,000
.28
9 Multiply line 6 by the decimal amount on line 8. If you paid 2006 expenses in 2007, see the
Federal Form 2441 instructions. Enter here and on line 1 of the Refundable Child/Dependent Care
Worksheet (page 9 of Form 1040N instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
8-618-2007
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