Form 2441 Child and Dependent Care Expenses
Summary: This is a sample Form 2441 (2011), Page 1 pertaining to the example explained in the text, with additional line item information not listed in the
text.
- Name(s) shown on Form 1040 field contains Joan Thomas
- Your social security number field contains 559-00-3436
- Under Part I: Persons or Organizations Who Provided the Care:
-
- 1(a) Care provider's name field contains Pat Green and ACME
Computers
- 1(b) Address (number, street, apartment number, city, state, and ZIP code) field contains 12 Ash Avenue, Hometown, Texas 75240 and (See
W-2)
- 1(c) Identifying number (Social Security Number or Employer Identification Number) field contains
240-00-3811
- 1(d) Amount paid (see instructions) field contains 2,400
- Under Part II: Credit for Child and Dependent Care Expenses:
-
- 2(a) Qualifying person's name: First field contains Seth and
Susan
- 2(a) Qualifying person's name: Last field contains Thomas and
Thomas
- 2(b) Qualifying person's social security number field contains 559-00-1234 and
559-00-5678
- 2(c) Qualified expenses you incurred and paid in 2008 for the person listed in column (a) field contains
2,400
- 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 35 field contains
2,400
- 4. Enter your earned income field contains 29,000
- 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
29,000
- 6. Enter the smallest of line 3, 4, or 5 field contains 2,400
- 7. Enter the amount from Form 1040, line 38 field contains
29,000
- 8. Enter on line 8 the decimal point 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 2010 expenses in 2011, see the instructions field contains
672
- 10. Tax liability limit. Enter the amount from the Credit limit worksheet in the instructions. field contains
943
- 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
672
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