Form 2441 (2009) Page 2

• Under Part III: Dependent Care Benefits:
• • 12. Enter the total amount of dependent care benefits you received for 2010. 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
  • 13. Enter the amount, if any, you carried over from 2009 and used in 2010 during the grace period. field contains 0
  • 14. Enter amount, if any, you forfeited or carried forward to 2011. field contains 0
  • 15. Combine lines 12 through 14. field contains 3,000
  • 16. Enter the total amount of qualified expenses incurred in 2010 for the care of the qualifying person(s) field contains 5,400
  • 17. Enter the smaller of 15 or 16 field contains 3,000
  • 18. Enter your earned income field contains 29,000
  • 19. 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 instructions; All others, enter the amount from line 18 field contains 29,000
  • 20. Enter the smallest of line 17, 18, or 19 field contains 3,000
  • 21. Enter $5,000 ($2,500 if married filing separately and you were required to enter your spouse's earned income on line 19. field contains 5,000.
  • 22. Is any amount on line 12 from your sole proprietorship or partnership? (Form 1040A filers go to line 25
  • No. Enter zero.
  • Yes. Enter the amount here.
  • 23. Subtract line 22 from line 15 field contains 3,000.
  • 24. Deductible benefits. Enter the smallest of line 20, 21, or 22. Also, include this amount on the appropriate line(s) of your return (see instructions).Field contains 0.
  • 25. Excluded benefits. Form 1040 and 1040NR filers: If you checked No on line 22, enter the smaller of line 20 or 21. Otherwise, subtract line 24 from the smaller of line 20 or line 212. If zero or less, enter -0-. Form 1040A filers: Enter the smaller of line 20 or line 21. Field contains 3,000.
  • 26. Taxable benefits. Form 1040 and 1040NR filers: Subtract line 25 from line 23. If zero or less, enter -0-. Also, include this amount on Form 1040, line 7, or Form 1040NR, line 8, On the dotted line next to Form 1040, line 7; or Form 1040NR, line 8, enter DCB. Form 1040A filers: Subtract line 25 from line 15. 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 27 through 31 below:
• • 27. Enter $3,000 ($6,000 if two or more qualifying persons) field contains 6,000
  • 28. Form 1040 and 1040NR filers: Add lines 24 and 25. Form 1040A filers: Enter the amount from line 25. field contains 3,000
  • 29. Subtract line 28 from line 27. If zero or less, stop. You cannot take the credit. Exception. If you paid 2009 expenses in 2010, see the instructions for line 9 field contains 3,000
  • 30. Complete line 2 on the front of this form. Do not include in column (c) any benefits shown on line 28 above. Then, add the amounts in column (c) and enter the total here field contains 2,400
  • 31. Enter the smaller of line 29 or 30. Also, enter this amount on line 3 on the front of this form and complete lines 4 through 11 field contains 2,400

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