Form 8839 - Qualified Adoption Expenses - 2017 Page 2
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Form 8839 (2017)
Page
Part III
Employer-Provided Adoption Benefits
Child 1
Child 2
Child 3
$13,570 00
$13,570 00
$13,570 00
17
Maximum exclusion per child
17
18
Did you receive employer-
provided adoption benefits for a
prior year for the same child?
}
No. Enter -0-.
18
Yes. See instructions for
the amount to enter.
19
Subtract line 18 from line 17
19
20
Employer-provided adoption
benefits you received in 2017.
This amount should be shown
in box 12 of your 2017 Form(s)
W-2 with code T
20
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21
Add the amounts on line 20 .
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21
22
Enter the smaller of line 19 or
line 20. But if the child was a
child with special needs and the
adoption became final in 2017,
22
enter the amount from line 19
23
Enter modified adjusted gross income (from
the worksheet in the instructions) .
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23
24
Is line 23 more than $203,540?
No. Skip lines 24 and 25, and enter -0-
on line 26.
Yes. Subtract $203,540 from line 23
24
25
Divide line 24 by $40,000. Enter the result as a decimal (rounded to
×
at least three places). Do not enter more than 1.000 .
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25
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26
Multiply each amount on line 22
by line 25 .
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26
27
Excluded benefits. Subtract
line 26 from line 22 .
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27
28
Add the amounts on line 27 .
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28
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29
Taxable benefits. Is line 28 more than line 21?
No. Subtract line 28 from line 21. Also, include this amount, if more than zero, on
line 7 of Form 1040 or line 8 of Form 1040NR. On the dotted line next to line
7 of Form 1040 or line 8 of Form 1040NR, enter “AB.”
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29
Yes. Subtract line 21 from line 28. Enter the result as a negative number. Reduce
the total you would enter on line 7 of Form 1040 or line 8 of Form 1040NR by
the amount on Form 8839, line 29. Enter the result on line 7 of Form 1040 or
line 8 of Form 1040NR. Enter “SNE” on the dotted line next to the entry line.
You may be able to claim the adoption credit in Part II on the front of this form if any of the following apply.
• You paid adoption expenses in 2016, those expenses were not fully reimbursed by your employer or otherwise, and
the adoption was not final by the end of 2016.
TIP
• The total adoption expenses you paid in 2017 were not fully reimbursed by your employer or otherwise, and the
adoption became final in 2017 or earlier.
• You adopted a child with special needs and the adoption became final in 2017.
8839
Form
(2017)
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