Form 2441 - Child And Dependent Care Expenses - 2017

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2441
OMB No. 1545-0074
Child and Dependent Care Expenses
1040
. . . . . . . . . .
Form
1040A
2017
. . . . . . . . . .
Attach to Form 1040, Form 1040A, or Form 1040NR.
1040NR
2441
Department of the Treasury
Go to for instructions and the
Attachment
21
Internal Revenue Service (99)
latest information.
Sequence No.
Your social security number
Name(s) shown on return
Part I
Persons or Organizations Who Provided the Care—You must complete this part.
(If you have more than two care providers, see the instructions.)
1
(a) Care provider’s
(b) Address
(c) Identifying number
(d) Amount paid
name
(number, street, apt. no., city, state, and ZIP code)
(SSN or EIN)
(see instructions)
No
Complete only Part II below.
Did you receive
dependent care benefits?
Yes
Complete Part III on the back next.
Caution: If the care was provided in your home, you may owe employment taxes. If you do, you can't file Form 1040A. For details, see
the instructions for Form 1040, line 60a, or Form 1040NR, line 59a.
Part II
Credit for Child and Dependent Care Expenses
2
Information about your qualifying person(s). If you have more than two qualifying persons, see the instructions.
(c) Qualified expenses you
(a) Qualifying person’s name
(b) Qualifying person’s social
incurred and paid in 2017 for the
security number
Last
First
person listed in column (a)
Add the amounts in column (c) of line 2. Don't enter more than $3,000 for one qualifying
3
person or $6,000 for two or more persons. If you completed Part III, enter the amount
from line 31 .
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3
4
Enter your earned income. See instructions
4
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5
If married filing jointly, enter your spouse’s earned income (if you or your spouse was a
student or was disabled, see the instructions); all others, enter the amount from line 4
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5
6
Enter the smallest of line 3, 4, or 5
6
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7
Enter the amount from Form 1040, line 38; Form
1040A, line 22; or Form 1040NR, line 37 .
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7
8
Enter on line 8 the decimal amount shown below that applies to the amount on line 7
If line 7 is:
If line 7 is:
But not
Decimal
But not
Decimal
Over
over
amount is
Over
over
amount is
$0—15,000
.35
$29,000—31,000
.27
15,000—17,000
.34
31,000—33,000
.26
X
8
.
17,000—19,000
.33
33,000—35,000
.25
19,000—21,000
.32
35,000—37,000
.24
21,000—23,000
.31
37,000—39,000
.23
23,000—25,000
.30
39,000—41,000
.22
25,000—27,000
.29
41,000—43,000
.21
27,000—29,000
.28
43,000—No limit
.20
9
Multiply line 6 by the decimal amount on line 8. If you paid 2016 expenses in 2017, see
the instructions .
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9
10
Tax liability limit. Enter the amount from the Credit
Limit Worksheet in the instructions.
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10
11
Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10
here and on Form 1040, line 49; Form 1040A, line 31; or Form 1040NR, line 47 .
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11
2441
For Paperwork Reduction Act Notice, see your tax return instructions.
Form
(2017)
Cat. No. 11862M

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