Employer-Assisted Day Care Tax Credit Worksheet For Tax Year 2012

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EMPLOYER-ASSISTED DAY CARE TAX CREDIT
WORKSHEET FOR TAX YEAR 2012
36 M.R.S.A. § 5217
TAXPAYER NAME: _____________________________________ EIN/SSN: ________________
Note: Owners of pass-through entities (partnerships, LLCs, S corporations, trusts, etc.) making an eligible
investment, see instructions. Enter name and ID number of the entity on the lines below.
NAME OF PASS-THROUGH ENTITY
EIN/SSN
________________________________________________________________
____________________________
1. Number of employees’ children enrolled full-time (or number of full-time equivalents)
in day care services provided/paid for by the employer in 2012 (see instructions) ..........1. _____________________
2. Line 1 x $100 ...................................................................................................................2. _____________________
3. Actual costs incurred in providing day care services for children of
employees for the taxable year ........................................................................................3. _____________________
4. Line 3 x 20% (0.20) ..........................................................................................................4. _____________________
5. Enter the lowest of line 2, line 4 or $5,000 .......................................................................5. _____________________
6. Do any of the day care services provided in 2012 qualify as quality child care
 Yes
services? (see instructions) ................................................................................................
No
If yes, enter the certifi cate number(s) ________________________
of the quality child care certifi cate(s) issued to the facility by the Department of
Health and Human Services, Offi ce of Child Care and Head Start.
Enter credit amount from line 5 that relates to amounts paid for quality child care
services ............................................................................................................................6. _____________________
7. Line 6 x 2 .........................................................................................................................7. _____________________
8. Line 5 minus line 6 (not less than zero) ...........................................................................8. _____________________
9. Current year credit claimed (line 7 plus line 8) .................................................................9. _____________________
10. Credit carried forward/back from other tax years (see instructions) ..............................10. _____________________
11. Total credit available this year (line 9 plus line 10). Corporate taxpayers, enter this
amount on Form 1120ME, Schedule C, line 29c. Individuals, enter this amount on
Form 1040ME, Schedule A, line 18 ............................................................................... 11. _____________________
The credit may not exceed the amount of regular income tax otherwise
due. The credit cannot be applied against the corporate alternative
minimum tax. Any unused credit may be carried forward to the following
year or years for a period not to exceed 15 years or it may be carried
back for a period not to exceed 3 years.
Rev. 4/13

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