MONTANA
RESET
DCAC
Rev 08 10
2010 Dependent Care Assistance Credits
Name (as it appears on your tax return) ______________________________________________________________
Your Social Security Number or Federal Employer 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 _______ %
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 prior year’s tax returns ............................................................................................................. 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.
You are required to attach supporting documentation showing that the person who operated your
day care facility on the last day of your tax year is licensed or registered to operate your facility.
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%); 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 .............
Enter the amount from Part IV above on your appropriate tax return:
Form 2, Schedule V
Form CLT-4S, Schedule II
Form CLT-4, Schedule C
Form PR-1, Schedule II
When you fi le 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. If you fi le electronically, you do not need to mail this form to us unless we contact you for a copy.
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