Form 8839 - Qualified Adoption Expenses
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28839
Qualified Adoption Expenses
OMB No. 1545-0074
2015
Form
Attach to Form 1040 or 1040NR.
Department of the Treasury
Attachment
▶
38
Sequence No.
Internal Revenue Service (99)
For information about Form 8839 and its separate instructions, see
▶
Name(s) shown on return
Your social security number
Part I
Information About Your Eligible Child or Children—You must complete this part. See instructions for
details, including what to do if you need more space.
Check if child was—
(g)
(a)
(b)
(f)
Check if
(c)
(d)
(e)
1
Child’s name
Child’s year
Child’s
adoption
born before
a child
a
of birth
identifying number
became final in
1998 and
with special
foreign
2015 or earlier
First
Last
disabled
needs
child
Child
1
Child
2
Child
3
Caution. If the child was a foreign child, see Special rules in the instructions for line 1, column (e), before you complete Part II or
Part III. If you received employer-provided adoption benefits, complete Part III on the back next.
Part II
Adoption Credit
Child 1
Child 2
Child 3
2
Maximum adoption credit per
$13,400 00
$13,400 00
$13,400 00
2
child
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3
Did you file Form 8839 for a
prior year for the same child?
}
No. Enter -0-.
3
Yes. See instructions for
the amount to enter.
4
Subtract line 3 from line 2
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4
5
Qualified adoption expenses
(see instructions)
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5
Caution.
Your
qualified
adoption expenses may not be
equal to the adoption expenses
you paid in 2015.
6
Enter the smaller of line 4 or line 5
6
7
7
Enter modified adjusted gross income (see instructions) .
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8
Is line 7 more than $201,010?
No. Skip lines 8 and 9, and enter -0- on line 10.
Yes. Subtract $201,010 from line 7 .
8
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9
Divide line 8 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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9
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10
Multiply each amount on line 6
by line 9
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10
11
Subtract line 10 from line 6 .
11
12
Add the amounts on line 11 .
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12
13
Credit carryforward, if any, from prior years. See your Adoption Credit Carryforward Worksheet
in the 2014 Form 8839 instructions
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13
14
Add lines 12 and 13
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14
15
15
Enter the amount from line 5 of the Credit Limit Worksheet in the instructions
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16
Adoption Credit. Enter the smaller of line 14 or line 15 here and on Form 1040, line 54, or Form
1040NR, line 51. Check box c on that line and enter “8839” in the space next to box c. If line 15
16
is smaller than line 14, you may have a credit carryforward (see instructions) .
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8839
For Paperwork Reduction Act Notice, see your tax return instructions.
Form
(2015)
Cat. No. 22843L
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