MONTANA
RESET
DCAC
Rev 05 11
2011 Dependent Care Assistance Credits
Name (as it appears on your Montana tax return)
Social Security
Federal Employer
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OR
Number
Identifi cation Number
If this credit is passed through to you from a partnership or S corporation, enter the entity’s name and FEIN. If a
partnership, enter the percentage used to report the partnership’s income or loss for Montana income tax purposes; or if
an S corporation, enter the pro rata share of the corporation’s qualifying costs.
Name ___________________________________ FEIN
Percentage _______ %
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Part I. Day Care Facilities Credit (15-30-2365 and 15-31-133, MCA)
1. Enter original amount of day care facility credit calculated. This is your total credit that is
allocated over 10 tax years.............................................................................................................. 1.
2. Multiply line 1 by 0.10 (10%). This is your annual allocated credit amount ..................................... 2.
3. Enter the amount available to be carried forward from prior tax years. This is the difference
between the sum of your annual allocated credits and the sum of the actual credits allowed on
your tax returns from prior years ..................................................................................................... 3.
4. Add lines 2 and 3. This is your day care facilities credit available for the current year. .......... 4.
5. Enter the amount of credit claimed in the current tax year .............................................................. 5.
6. Subtract line 5 from line 4. This is your credit available to be carried forward to the next tax year
and added to your annual allocated credit....................................................................................... 6.
Please provide the provider number of the person operating the day-care facility on the last day of
the tax year for which the credit is claimed ___________________________________________
Part II. Dependent Care Assistance Credit (15-30-2373 and 15-31-131, MCA)
1. Enter here the total amount of dependent care assistance that you furnished your employees ..... 1.
2. Enter here the total number of employees who were provided this service .................................... 2.
3. Divide the amount on line 1 by the number on line 2 and enter that result or $6,300,
whichever is smaller ........................................................................................................................ 3.
4. Multiply the amount on line 3 by 0.25 (25%) and enter that result or $1,575, whichever is smaller 4.
5. Multiply the amount on line 4 by the amount on line 2 and enter the result here. This is your
dependent care assistance credit. ............................................................................................... 5.
Part III. Dependent Care Information and Referral Services Credit (15-30-2373 and 15-31-131, MCA)
1. Enter here the total amount that you paid or incurred during the year for providing information
and referral services to your employees.......................................................................................... 1.
2. Multiply the amount on line 1 by 0.25 (25%) and enter the result here. This is your dependent
care information and referral services credit. ............................................................................ 2.
Part IV. Combined Credits
Add the amounts on Part I, line 4; Part II, line 5; and Part III, line 2. This is your combined
dependent care assistance credit. Your combined credit cannot exceed your tax liability .............
Where to Report Your Credit
►Individuals: Form 2, Schedule V
►S corporations: Form CLT-4S, Schedule II
►C corporations: Form CLT-4, Schedule C
►Partnerships: Form PR-1, Schedule II
If you fi le your Montana tax return electronically, you do not need to mail this form to us unless we ask you for a copy. When you fi le electronically, you
represent that you have retained the required documents in your tax records and will provide them upon the department’s request.
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