Form Dr 0347 - Child Care Expenses Tax Credit Page 2
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3DR 0347 (09/10/15)
*150347==19999*
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0005
Child Care Expenses Tax Credit
Submit this form with your complete Colorado Individual Income Tax Return, including forms 104 and 104CR.
You must also submit a copy of IRS form 2441 with your Colorado return.
Thoroughly read the instructions to be certain you are eligible for this credit.
Be sure to complete all required information. Failure to do so may result in a denied credit or delayed refund.
Taxpayer Name
SSN
Part I – Persons or Organizations Who Provided the Care - You must complete this part
If you have more than two care providers or if the provider is non-profit, see the instructions.
Last Name
Middle Initial
(b) SSN or FEIN
(a) Care Provider’s First Name
1.
(c) Address
State
Zip
(d) Amount Paid
City
$
(a) Care Provider’s First Name
Last Name
Middle Initial
(b) SSN or FEIN
(c) Address
State
Zip
(d) Amount Paid
City
$
Part II – Qualifying Child Information - You must complete this part
If you have more than four qualifying children, see the instructions.
Last Name
Middle Initial Year of Birth
Child’s First Name
2(a).
SSN
Qualified expenses you incurred and paid in 2015 for the person listed in 2(a) $
Last Name
Middle Initial Year of Birth
Child’s First Name
2(b).
SSN
Qualified expenses you incurred and paid in 2015 for the person listed in 2(b) $
Last Name
Middle Initial Year of Birth
Child’s First Name
2(c).
SSN
Qualified expenses you incurred and paid in 2015 for the person listed in 2(c) $
Last Name
Middle Initial Year of Birth
Child’s First Name
2(d).
SSN
Qualified expenses you incurred and paid in 2015 for the person listed in 2(d) $
2(e). Enter the sum of all qualified child care expenses
$
$
2(f). Enter your earned income
2(g). If filing a joint return, enter the earned income of the other person
$
3. Enter the smallest of line 2(e), 2(f) [or 2(g) only if filing a joint return]
3 $
4. Enter your adjusted gross income from your federal income tax return.
See IRS form 1040 line 37 or 1040A line 21
4 $
If the amount of line 4 is greater than $60,000 STOP - you do not qualify for this credit.
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