Schedule Nd-1fc - Family Member Care Income Tax Credit - 2013
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1
2Schedule
North Dakota Offi ce of State Tax Commissioner
ND-1FC
2013
Family member care income tax credit
Attach to Form ND-1
Name(s) shown on return
Social security number
If you paid qualifi ed care expenses for more than one qualifying family member, complete a separate Schedule ND-1FC for each qualifying family
•
member.
See the instructions on the other side of this schedule for defi nitions of qualifying family member and qualifi ed care expenses.
•
Qualifying family member criteria
Is the family member related to you by blood or marriage? .........................................................................
Yes
No
A.
If yes, enter your relationship to the family member ..................................... __________________________
Is the family member either (1) at least 65 years old or (2) disabled as defi ned by the
B.
Social Security Administration? If disabled, attach a copy of a supporting letter — see instructions
.................
Yes
No
.
C.
If the family member is not married, is the family member’s federal taxable income equal to or less
than $20,000? If the family member is married, is the total federal taxable income of the family member and
the family member’s spouse equal to or less than $35,000? ........................................................................
Yes
No
If you answered YES to all of the questions in Items A through C above, go to Item D.
•
If you answered NO to any question in Items A through C above, stop here; you do not have a qualifying family member.
•
Name of qualifying family member ...........................................................................................
_________________________
D.
►
Social security number of qualifying family member
E.
...............................................................
►
_________________________
Calculation of tax credit
Qualifi ed care expenses paid by you during the tax year (for the qualifying family member identifi ed above)
1.
(Attach a statement showing type and amount of expenses. If payment is for services, also identify provider)
1 _________________
2.
Of the expenses included on line 1, enter the amount deducted on federal return .....................................
2 _________________
Eligible qualifi ed care expenses (Subtract line 2 from line 1. If less than zero, enter -0-) .....................
3.
(FA)
3 _________________
Your federal taxable income (from line 43 of Form 1040, line 27 of Form 1040A,
4.
or line 6 of Form 1040EZ) .....................................................................................
4 _______________
(FB)
Decimal amount (from applicable table below) (If Married Filing Separately, use Table 2 to fi nd income range,
5.
then enter one-half of decimal amount for that range) .........................................................................
5
_________
(FC)
Table 1: Single/Head of household/Qualifying widow(er)
Table 2: Married fi ling joint
If the amount
Decimal
If the amount
Decimal
If the amount
Decimal
If the amount
Decimal
on line 4 is:
amount is:
on line 4 is:
amount is:
on line 4 is:
amount is:
on line 4 is:
amount is:
Over
Not over
Over
Not over
Over
Not over
Over
Not over
$
0 $ 25,000
.30
$ 35,000 $ 37,000
.24
$
0 $ 35,000
.30
$ 45,000 $ 47,000
.24
25,000
27,000
.29
37,000
39,000
.23
35,000
37,000
.29
47,000
49,000
.23
27,000
29,000
.28
39,000
41,000
.22
37,000
39,000
.28
49,000
51,000
.22
29,000
31,000
.27
41,000
43,000
.21
39,000
41,000
.27
51,000
53,000
.21
31,000
33,000
.26
43,000
No limit
.20
41,000
43,000
.26
53,000
No limit
.20
33,000
35,000
.25
43,000
45,000
.25
Multiply line 3 by line 5 ....................................................................................................................
6.
(FD)
6 _________________
Maximum credit allowed per qualifying family member. Enter $2,000 if Single, Married Filing Jointly,
7.
Head of Household, or Qualifying Widow(er), or $1,000 if Married Filing Separately .................................
7 ________________
(FE)
Enter smaller of line 6 or line 7 .........................................................................................................
8.
8 _______________
(FF)
9.
Federal taxable income limit. Enter $50,000 if Single, Head of Household, or Qualifying Widow(er),
.................
or $70,000 if Married Filing Jointly, or $35,000 if Married Filing Separately
9 _________________
(FG)
Subtract line 9 from line 4 (If less than zero, enter -0-) ..............................................................
10.
10 _______________
(FH)
Tentative family member care credit (Subtract line 10 from line 8) (If less than zero, enter -0-)
11.
See below for the amount you may enter on your return ..............................................................
11 _______________
(FI)
If you are claiming this credit for only one qualifying family member, enter the amount from line 11
•
of Schedule ND-1FC on Schedule ND-1TC, line 1.
•
If you are claiming this credit for more than one qualifying family member, add the separately calculated credits from line 11
of all Schedule ND-1FC forms. Your allowable credit is limited to the smaller of the sum of the separately calculated credits
or $4,000 ($2,000, if you are Married Filing Separately). Enter your allowable credit on Schedule ND-1TC, line 1.
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