Schedule M1cd - Child And Dependent Care Credit - 2014

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201477
2014
Schedule M1CD, Child and Dependent Care Credit
Sequence #5
The instructions for this schedule are on a separate sheet.
Your First Name and Initial
Last Name
Social Security Number
Children or other qualifying persons for whom you are claiming this credit (see instructions for defi nition of qualifying person):
Name
Birth Date (mmddyyyy)
Social Security Number
Persons or organizations who provided the care:
Social Security Number
Name
Amount paid
(or federal business ID number)
Place an X in this box if you operate a licensed family day care home and are claiming the credit for your own child(ren).
Enter your day care license number:
.
Place an X in this box if you are a married couple fi ling jointly and are claiming the credit for your child born in 2014
Round amounts to the nearest whole dollar.
All Applicants
1 Federal adjusted gross income (from line 37 of federal Form 1040,
line 21 of Form 1040A, or line 4 of Form 1040EZ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Nontaxable Social Security and/or Railroad Retirement Board benefi ts received
and not included in line 1 above (include amounts deducted for medicare premiums) . . . . . . . . . . . . . . . 2
3 Deduction for payments made to an IRA, SEP or SIMPLE plan (add lines 28 and 32 of Form 1040
or line 17 of Form 1040A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Total payments from programs including MFIP (Minnesota Family Investment Program),
MSA (Minnesota Supplemental Aid), SSI (Supplemental Security Income), GA (General Assistance)
and GRH (Group Residential Housing) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Additional nontaxable income - such as contributions to a 401(k) or deferred compensation
plan and scholarships and grants - that you must include (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . .5
Enter total and type(s) of income
6 Household income. Add lines 1 through 5 (if result is zero or less, enter 0) . . . . . . . . . . . . . . . . . . . . . . . . . 6
If line 6 is more than $39,000, STOP HERE. You are not eligible for the credit.
7 Credit amount (from the table on page 2 of this form) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8
Amount from line 9 of federal Form 2441 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Amount from line 7 or line 8, whichever is less. Full-year residents, enter the result here
and on line 24 of Form M1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Part-Year Residents, Nonresidents, American Indians Living on a Reservation and Taxpayers with
JOBZ Business Income
10 If you are married
If you are single
. . . . 10
add lines 4 and 5 of federal Form 2441.
enter line 4 of Form 2441
11 Portion of the amount on line 10 that is taxable to Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
.
12 Divide Line 11 by line 10. Enter the result as a decimal (carry to fi ve decimal places) . . . . . . . . . . . . . . . 12
13 Multiply line 9 by line 12. Enter the result here and on line 24 of Form M1 . . . . . . . . . . . . . . . . . . . . . 13
Include this schedule and a copy of your federal Form 2441 with your Form M1.
Enter the number of qualifying persons in the box provided on line 24 on Form M1.
9995

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