Form N-11/n-15 - Tax Credits For Hawaii Residents Page 2

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SCHEDULE X (FORM N-11/N-15) (REV. 2016)

PAGE 2

Name(s) as shown on Form N-11 or N-15

Your social security number

YCF162

6 Enter the total amount of qualified expenses incurred in 2016 for the care of the qualifying person(s). ....

7 Enter the smaller of line 5 or 6. .....................................................................................

8 Enter your earned income. (See the Instructions) ........................................................

9 If married filing jointly, enter your spouse’s earned income (if you or your spouse

was a student or disabled, see the Instructions); if married filing separately,

see the Instructions; all others, enter the amount from line 8. ......................................

10 Enter the smallest of line 7, 8, or 9. ..............................................................................

11 Enter $5,000 ($2,500 if married filing separately and you were required to enter your

spouse’s earned income on line 9). ..............................................................................

12 Is any amount on line 2 from your sole proprietorship or partnership?

No. Enter -0-.

Yes. Enter the amount here. ..............................................................................................................................................

13 Line 5 minus line 12 ......................................................................................................

14 Deductible benefits. Enter the smallest of line 10, 11, or 12. Also, include this amount on the appropriate line(s) of

your return. .........................................................................................................................................................................

15 Excluded benefits. If line 12 is zero, enter the smaller of line 10 or 11. Otherwise, subtract line 14 from the smaller of

line 10 or 11. If zero or less, enter -0-. ...............................................................................................................................

16 Taxable benefits. Line 13 minus line 15. If zero or less, enter -0-. Also, include this amount on Form N-15, line 7.

On the corresponding dotted line write “DCB.” (Form N-11 filers, see the Instructions) ....................................................

17 Enter $2,400 ($4,800 if two or more qualifying persons) ...................................................................................................

18 Add lines 14 and 15. .........................................................................................................................................................

19 Line 17 minus line 18. If zero or less, STOP. You cannot take the credit. Exception. If you paid 2015 expenses in

2016, see the Instructions for line 28. ................................................................................................................................

20 Complete line 21. Do not include in column (d) any benefits shown on line 18. Then, add the amounts in column (d)

and enter the total here. .....................................................................................................................................................

Section C: Credit for Child and Dependent Care Expenses

— (If you are married, you must file a joint return to claim the tax credit.)

(d) Qualified expenses

(a) Qualifying person’s name

(b) Relationship

you incurred and paid

security number

in 2016 for the person

listed in column (a)

22 Add the amounts in column (d) of line 21. Do not enter more than $2,400 for one qualifying person or $4,800 for two

or more persons. If you completed Section B, enter the smaller of line 19 or 20. .....................................................................

23 Enter your earned income. (See the Instructions) .............................................................................................................

24 If married filing jointly, enter your spouse’s earned income (if you or your spouse was a student or disabled,

see the Instructions); all others, enter the amount from line 23 .........................................................................................

25 Enter the smallest of line 22, 23, or 24. .............................................................................................................................

26 Enter your adjusted gross income from Form N-11, line 20; or Form N-15, line 35,

Column A ......................................................................................................................

27 Enter on line 27 the decimal amount shown below that applies to the amount on line 26.

If line 26 is:

Decimal amount is:

If line 26 is:

Decimal amount is:

Under $25,001

.25

$40,001 – 45,000

.21

$25,001 – 30,000

.24

$45,001 – 50,000

.20

$30,001 – 35,000

.23

$50,001 and over

.15

$35,001 – 40,000

.22

28 Multiply line 25 by the decimal amount on line 27. If you paid 2015 expenses in 2016, see the Instructions.

Enter the result here and on Form N-11, line 30; or Form N-15, line 47. This is your credit for child and

dependent care expenses. (Whole dollars only) ................................................................................................................