Form 5217-D - Educational Opportunity Tax Credit Worksheet For Employers - 2016

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2016 Educational Opportunity Tax Credit Worksheet
for Employers (36 M.R.S. § 5217-D)
Employer name: ________________________________________
EIN: _________________________
A. Qualifi ed Employee name: _____________________________
B.
Check the type of degree employee received: ___ Bachelor’s ___ Associate
___ Graduate
Date of graduation: ___/___/_____
C.
Location at which qualifi ed employee worked: _______________________________________________________________________________
1.
Enter the monthly eligible education loan payment due during employer's 2016 tax year ..............................1.
$ ______________________
2.
Enter the monthly eligible education loan payment amount paid by you and the employee
during your 2016 tax year ......................................................................................................................................2.
$ ______________________
3.
Enter the lesser of lines 1 and 2 ............................................................................................................................3.
$ ______________________
4.
a. Enter the number of months* during your tax year the employee was a Maine resident ...............................4a.
______________________
b. With respect to the months on line 4a, enter the number of months* the employee worked in Maine or
was deployed for military service in the U.S. Armed Forces, or was employed at least part-time on a
vessel at sea (see page 2 for a defi nition of "worked in Maine") ...................................................................4b.
______________________
c. With respect to the months on line 4b, enter the number of months* you and the employee made
eligible education loan payments ................................................................................................................... 4c.
______________________
* Count any part of a month as a whole month.
5.
Gross Credit. Multiply line 3 by line 4c ................................................................................................................5.
$ ______________________
6.
a. Enter the eligible education loan amount you paid directly to the lender during your tax year,
excluding any amount exceeding the amount due .........................................................................................6a.
$ ______________________
b. Enter the total eligible education loan amount paid during your tax year by you and the employee,
excluding any amount exceeding the amount due ........................................................................................6b.
$ ______________________
c. Divide line 6a by line 6b and enter the result here ......................................................................................... 6c.
___ . ___ ___ ___ ___
7.
Modifi ed gross credit. Multiply line 5 by line 6c .................................................................................................7.
$ ______________________
Note: If all credit hours for the employee's degree were earned after 2007, skip lines 8, 9 and 10
and enter the amount from line 7 on line 11.
8.
Enter the number of credit hours earned toward the degree after December 31, 2007 ........................................8.
_______________________
9.
Enter the total number of credit hours earned toward the degree .........................................................................9.
_______________________
10. Divide line 8 by line 9 ..........................................................................................................................................10.
___ . ___ ___ ___ ___
11. If you completed lines 8, 9 and 10, multiply line 7 by line 10. Otherwise, enter the amount from line 7 ............ 11.
$ ______________________
12. If the employee worked for you full time (at least 32 hours/week), enter 1.0 (see instructions) ..........................12.
___ . ___
If the employee worked for you part-time (at least 16 hours/week), enter 0.5.
13. Credit amount. Multiply line 11 by line 12 ...........................................................................................................13.
$ ______________________
14. Enter the carryforward of unused credit amount from prior tax years .................................................................14.
$ ______________________
15. Total credit available (line 13 plus line 14).
C corporations: Add the line 15 amounts of all worksheets completed and enter the total on
Form 1120ME, Schedule C, line 29l.
Sole proprietors: Add the line 15 amounts of all worksheets completed and enter the total on
Form 1040ME, Schedule A, line 13.
Pass-through entities: Enter the result here and see instructions for reporting amounts to owners ...............15.
$ ______________________
Unused credit amounts on line 13 may be carried forward to future tax years for up to 10 years. See instructions.
IMPORTANT - Maine Revenue Services may request supporting documentation, including, but not limited to, the following: copy of college transcript,
proof of the educational loans that qualify for the credit, proof of the educational loan payments made by you or your employee during the tax year.
Revised December 2016

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