Form 2441 - Child And Dependent Care Expenses
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1
22441
OMB No. 1545-0074
Child and Dependent Care Expenses
Form
2005
Attach to Form 1040.
Attachment
Department of the Treasury
21
See separate instructions.
(99)
Sequence No.
Internal Revenue Service
Name(s) shown on Form 1040
Your social security number
Before you begin: You need to understand the following terms. See Definitions on page 1 of the instructions.
● Qualifying Person(s)
● Qualified Expenses
● Dependent Care Benefits
Part I
Persons or Organizations Who Provided the Care—You must complete this part.
(If you need more space, use the bottom of page 2.)
(a) Care provider’s
(b) Address
(c) Identifying number
(d) Amount paid
1
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 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 two qualifying persons, see the instructions.
(c) Qualified expenses you
(a) Qualifying person’s name
(b) Qualifying person’s social
incurred and paid in 2005 for the
security number
First
Last
person 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
3
line 32
4
4
Enter your earned income. See instructions
5
If married filing jointly, enter your spouse’s earned income (if your spouse was a student
5
or was disabled, see the instructions); all others, enter the amount from line 4
6
6
Enter the smallest of line 3, 4, or 5
7
7
Enter the amount from Form 1040, line 38
8
Enter on line 8 the decimal amount shown below that applies to the amount on line 7
If line 7 is:
If line 7 is:
But not
Decimal
But not
Decimal
Over
over
amount is
Over
over
amount is
$0—15,000
.35
$29,000—31,000
.27
15,000—17,000
.34
31,000—33,000
.26
.
17,000—19,000
.33
33,000—35,000
.25
8
19,000—21,000
.32
35,000—37,000
.24
21,000—23,000
.31
37,000—39,000
.23
39,000—41,000
.22
23,000—25,000
.30
41,000—43,000
25,000—27,000
.29
.21
.28
27,000—29,000
43,000—No limit
.20
9
Multiply line 6 by the decimal amount on line 8. If you paid 2004 expenses in 2005, see
9
the instructions
10
10
Enter the amount from Form 1040, line 46, minus any amount on Form 1040, line 47
11
Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10
here and on Form 1040, line 48
11
2441
For Paperwork Reduction Act Notice, see page 4 of the instructions.
Cat. No. 11862M
Form
(2005)
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