Form 2441, Child and Dependent Care Expenses

Summary: This is an example of Form 2441, as pertains to the text. The completed line items are:

Name(s) shown on Form 1040A field contains Jerry & Ann Jones
Your social security number field contains 246-00-2468
Under Part I: Persons or organizations who provided the care:
- 1(a) Care provider's name field contains
- - Sue Smith
  - Pine Street Nursery School
- 1(b) Address (number, street, apartment number, city, state, and ZIP code) field contains
- - 413 Maple Street, Anytown, Pennsylvania 18605
  - 706 Pine Street, Anytown, Pennsylvania 18605
- 1(c) Identifying number (SSN. or EIN) field contains
- - 132-00-5467
  - 10-6754321
- 1(d) Amount paid (see instructions) field contains
- - 3,000
  - 3,200
Under Part II: Credit for child and dependent care expenses:
- 2. Information about your qualifying person(s). If you have more than two qualifying persons, see the instructions.
- (a) Qualifying person's name: First Last field contains
- - Daniel Jones
  - Amy Jones
- (b) Qualifying person's social security number field contains
- - 123-00-9876
  - 123-00-6789
- (c) Qualified expenses you incurred and paid in 2009 for the person listed in column (a) field contains
- - 3,000
  - 3,200
- 3. Add the amounts in column (c) of line 2. Do not enter more than $3,000 for one qualifying person or $6,000 for two or more persons. If you completed Part III, enter the amount from line 27. field contains 6,000
- 4. Enter your earned income. field contains 12,500
- 5. If married filing jointly, enter your spouse's earned income (if your spouse was a student or was disabled, see the instructions); all others, enter the amount from line 4. field contains 15,000
- 6. Enter the smallest of line 3, 4, or 5. field contains 6,000
- 7. Enter the amount from Form 1040A, line 22. field contains 27,500
- 8. Enter on line 8 the decimal amount shown below that applies to the amount on line 7. field contains .28
- 9. Multiply line 6 by the decimal amount on line 8. If you paid 2009 expenses in 2010, see the instructions. field contains 1,680
- 10. Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions. field contains 151
- 11. Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10 here and on Form 1040, line 48; Form 1040A, line 29; or Form 1040NR, line 46. field contains 151

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