Form 2441 (2009) Page 2

• Under Part III: Dependent Care Benefits:
• • 14. Enter the total amount of dependent care benefits you received for 2009. This amount should be shown in box 10 of your W-2 form(s). Do not include amounts that were reported to you as wages in box 1 of Form(s) W-2 field contains 3,000
  • 15. Enter the amount, if any, you carried over from 2008 and used in 2009 during the grace period. field contains 0
  • 16. Enter amount, if any, you forfeited or carried forward to 2010. field contains 0
  • 17. Combine lines 14 through 16. field contains 3,000
  • 18. Enter the total amount of qualified expenses incurred in 2009 for the care of the qualifying person(s) field contains 5,400
  • 19. Enter the smaller of 17 or 18 field contains 3,000
  • 20. Enter your earned income field contains 29,000
  • 21. Enter the amount shown below that applies to you. If married filing jointly, enter your spouse's earned income (if your spouse was a student or was disabled, see the instructions for line 5); If married filing separately, see page 4 of the instructions; All others, enter the amount from line 20 field contains 29,000
  • 22. Enter the smallest of line 19, 20, or 21 field contains 3,000
  • 23. Enter $5,000 ($2,500 if married filing separately and you were required to enter your spouse's earned income on line 21. field contains 5,000.
  • 24. Are you filing Form 1040A?
  • 25. Subtract line 24 from line 17 field contains -0-.
  • 26. Enter the smaller of line 22 or 23 field contains -0-.
  • 27. Deductible benefits. Enter the smallest of line 22, 23, or 25. Also, include this amount on the appropriate line(s) of your return (see the instructions).Field contains 0.
  • 28. Excluded benefits. Form 1040 and 1040NR filers: Subtract line 27 from line 26. If zero or less, enter -0-. Form 1040A filers: Enter the smaller of line 22 or line 23. Field contains -0-.
  • 29. Taxable benefits. Form 1040 and 1040NR filers: Subtract line 28 from line 25. If zero or less, enter -0-. Also, include this amount on Form 1040, line 7, or Form 1040NR, line 8,and enter DCB on the dotted line. Form 1040A filers: Subtract line 28 from line 17. Also, include this amount on Form 1040A, line 7. In the space to the left of line 7, enter DCB Field contains -0-.
• Under To claim the child and dependent care credit, complete lines 30 through 34 below:
• • 30. Enter $3,000 ($6,000 if two or more qualifying persons) field contains 6,000
  • 31. Form 1040 and 1040NR filers: Add lines 27 and 28. Form 1040A filers: Enter the amount from line 28. field contains 3,000
  • 32. Subtract line 31 from line 30. If zero or less, stop. You cannot take the credit. Exception. If you paid 2008 expenses in 2009, see the instructions for line 9 field contains 3,000
  • 33. Complete line 2 on the front of this form. Do not include in column (c) any benefits shown on line 31 above. Then, add the amounts in column (c) and enter the total here field contains 2,400
  • 34. Enter the smaller of line 32 or 33. Also, enter this amount on line 3 on the front of this form and complete lines 4 through 13 field contains 2,400

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