Form Dcac - Dependent Care Assistance Credit printable pdf download

MONTANA

DCAC

Rev. 8-04

Dependent Care Assistance Credit

Instructions on back

Name ___________________________________________________________ SSN or FEIN _____________________

You may be entitled to all three credits.

Day Care Facilities Credit

(15-30-130 and 15-31-133, MCA)

1. Enter number of dependents facility is designed to accommodate ....................................................... 1. ____________

2. Take $2,500 times the amount on line 1 ............................................................................................... 2. ____________

3. Enter cost of acquisition, construction, reconstruction, renovation or other improvements (see

instructions for determining cost) ......................................................................................................... 3. ____________

4. Enter 15% (.15) of line 3 ...................................................................................................................... 4. ____________

5. Enter the lesser of line 2, line 4 or $50,000 .......................................................................................... 5. ____________

6. Divide line 5 by ten (you are entitled to only 1/10

of the credit yearly) ................................................. 6. ____________

7. Enter carryforward amounts (excess annual credit over tax liability) ..................................................... 7. ____________

8. Add line 6 and line 7. This is your Day Care Facilities Credit ............................................................... 8. ____________

You must attach supporting documentation showing that the person operating the day care facility on the

last day of your tax year is licensed or registered to operate the facility. Without this documentation the

credit is denied.

Dependent Care Assistance Credit

(15-30-186 and 15-31-131, MCA)

9. Enter total amount of dependent care assistance you furnished your employees ................................. 9. ____________

10. Enter total number of employees who were furnished this service ...................................................... 10. ____________

11. Divide line 9 by line 10; enter that amount or $6,300, whichever is smaller .......................................... 11. ____________

12. Multiply line 11 by 25% (.25); enter that amount or $1,575, whichever is smaller .............................. 12. ____________

13. Multiply the amount on line 12 by the amount on line 10. This is your Dependent Care Assistance

Credit ................................................................................................................................................. 13. ____________

Any excess Dependent Care Assistance Credit not used the first year may be carried forward for five

years. It may not be carried back.

Dependent Care Information and Referral Service Credit

(15-30-186 and 15-31-131, MCA)

14. Amount paid or incurred during the year for providing information and referral services to employees. 14. ____________

15. Multiply line 14 by 25% (.25). This is your Dependent Care Referral Service Credit ........................... 15. ____________

Combined Credits

16. Add line 8, line 13 and line 15; enter total on line 16. This is your combined Dependent Care

Assistance Credit .............................................................................................................................. 16. ____________

For individual income tax, enter this amount on Form 2A, Schedule II. For corporation license tax, enter

this amount on Form CLT-4, Schedule C. Credit can not be larger than your tax liability.

Mail to:

Montana Department of Revenue

PO Box 5805

Helena, MT 59604-5805

When you file your Montana income tax return electronically you represent that you have retained all

documents required as a tax record and that you will provide a copy to the department upon request.

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