Employer-Assisted Day Care Tax Credit Worksheet For Tax Year 2015

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EMPLOYER-ASSISTED DAY CARE TAX CREDIT
WORKSHEET FOR TAX YEAR 2015
36 M.R.S. § 5217
TAXPAYER NAME: _____________________________________ EIN/SSN: ________________
Note: Owners of pass-through entities (such as partnerships, LLCs, S corporations, and trusts) making an eligible
investment, see instructions. Enter name and ID number of the entity on the lines below.
NAME OF PASS-THROUGH ENTITY
EIN/SSN
________________________________________________________________
____________________________
1. Number of employees’ children enrolled full-time (or number of full-time equivalents)
in day care services provided/paid for by the employer in 2015 (see instructions) ............1. ____________________
2. Line 1 x $100 .....................................................................................................................2. ____________________
3. Actual costs incurred in providing day care services for children of
employees for the taxable year ..........................................................................................3. ____________________
4. Line 3 x 20% (0.20) ............................................................................................................4. ____________________
5. Enter the lowest of line 2, line 4 or $5,000 .........................................................................5. ____________________
6. Do any of the day care services provided in 2015 qualify as quality child care
 Yes
services? (see instructions) .................................................................................................
No
If yes, enter the certifi cate number(s) of the quality child care certifi cate(s) issued to
the facility by the Department of Health and Human Services, Offi ce of Child
Care and Head Start. ________________________
Enter credit amount from line 5 that relates to amounts paid for quality child care
services ..............................................................................................................................6. ____________________
7. Line 6 x 2 ...........................................................................................................................7. ____________________
8. Line 5 minus line 6 (not less than zero) .............................................................................8. ____________________
9. Current year credit claimed (line 7 plus line 8) ...................................................................9. ____________________
10. Credit carried forward/back from other tax years (see instructions) ................................10. ____________________
11. Total credit available this year (line 9 plus line 10). Corporate taxpayers, enter this
amount on Form 1120ME, Schedule C, line 29c. Individuals, enter this amount on
Form 1040ME, Schedule A, line 20. Trusts and estates, enter this amount on Form
1041ME, Schedule A, line 16 ...........................................................................................11. ____________________
The credit may not exceed the amount of regular income tax otherwise due.
The credit cannot be applied against the corporate alternative minimum tax.
Any unused credit may be carried forward to the following year or years for
a period not to exceed 15 years or it may be carried back for a period not to
exceed three years.
Rev. 08/15

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