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Calendar year 1964, or other taxable year beginning

U.S. Treasury Department—Internal Revenue Service

STATEMENT OF EXPENSES FOR CARE OF CHILDREN AND
CERTAIN OTHER DEPENDENTS

1964, and ending -.

(ATTACH THIS STATEMENT TO YOUR INDIVIDUAL INCOME TAX RETURN)
The deduction for ‘child care” is not allowable if you take the standard deduction on Form 1040 or if you file Form 1040A

1, Name of taxpayer claiming the deduction -....

2, Status of taxpayer as of the time the expenses were incurred (check appropriate box)

O Single Married woman
O Married man—Wife institutionalized [] Widow
Note: If you checked more than one box do not use this form,

3. Name of child or other dependent for whom
expenses were paid

O) Married woman—Husband incapacitated
0 Widower
Contact any Internal Revenue Service office for further information.

If under 13 years of
age, please check

Married man—Wife incapacitated

01 Divorced 0) Legally separated.

If 13 years of age or over, explain reason for expenses
(see instruction B)

8, Total amount of expenses Paid, ..... sss eseeeeeeeeeeeesennscetsensseesoees eererrerrresrireey
6. Amount, if any, paid for services other than direct care of dependent(s) listed in line 3 (see instruction D) .
1. Balance (line 5 less line 6)...........4+ beeen ener aseneneeeneeeeneeeeereseees deen eeeeeeseneeee

8. Enter the amount from line 7 or $600 ($900 if two or more dependents), whichever is lesser (see instruction A)’.

9. Limitation for taxpayers filing a joint return (see instruction F);

(a) Enter amount shown on line 9, page 1, of your joint return, Form 1040 .

(b) Less ..

() Balance

10. Allowable deduction for taxpayers filing a joint return (line 8 less line-9).

COMPUTATION OF DEDUCTION

11. Enter the amount on line 8 or line 10, whichever is applicable, here and in “Other Deductions”, Part IV, page 2,
Form 1040......-++.-++++ sescessserereeetesecmesesessstsses teseseeees setec esse eee eeeeeees seteees eee

INSTRUCTIONS

A. A deduction not to exceed $600 for the care of one dependent,
$900 for the care of two or more dependents, is allowed for expenses
paid during the year by a woman or a widower if such care is for
the purpose of enabling such taxpayer to be gainfully employed.
However, if circumstances occurred which would change the max-
imum deduction, for example, $900 to $600, while these expenses
were being incurred, contact any Internal Revenue Service office
for method of determining the amount of your deduction. The term
“widower” means a man who has not remarried since his wife died
or since he was divorced. It also includes a man who is legall
separated from his wife. This deduction is now allowed a married
man for expenses incurred while his wife is incapacitated if she is
physically or mentally incapable of cating for herself for a period of at
Teast 90 consecutive days (whether or not within one faxable year)
or a shorter period if terminated by her death, In such case, enter
‘on the reverse side of this form the nature of her disability and the
period of her incapacitation, The deduction is not allowed for amounts
which you pay to a dependent for the care of another dependent.

B. The only dependents for whom the “child care” deduction is
allowed are those who are either (1) under 13 years of age, or (2)
physically or mentally incapable of caring for themselves,

C. In general for this expense to be deductible it must meet three
conditions: (1) The expense must be for the care of a dependent,
(2) it must be for a dependent's care while the taxpayer is gainfully
employed or in search of gainful employment, and (3) the expense
must be for the purpose of enabling the taxpayer to be gainfully
employed.

D. Expenses for the care of a dependent are amounts expended
for the primary purpose of assuring the dependent’s well-being and
protection. They do not include all benefits which may be bestowed
upon him, Accordingly, amounts expended to provide food, cloth-

ing, or education are not in themselves amounts expended for “care”
so as to be deductible. However, where the manner of providing
care is such that the expense which must be incurred includes pay-
ments for other benefits which are inseparably a part of the care,
the full amount will be considered to be incurred for care. Thus,
the full amount paid to a nursery school will be considered to be for
the care of the child, even though the school also furnished lunch,
recreational activities, and other benefits. In those cases in which
you pay a person to do both housework and take care of a dependent,
only that part of the expense which is for the dependent’s care
qualifies for the deduction.

E.’The deduction is allowed only with respect to such expenses
actually paid during the taxable year regardless of when incurred,

F, If the expenses are paid by a taxpayer who is married at the
time the expenses are incurred, the deduction is allowed if (1) the
wife files a separate return because she has been deserted by her
husband, did not know his whereabouts at any time during the year,
and has applied to a court to compel hiin to pay support or otherwise
to comply with the law or a judicial order (give details on reverse
side); (2) taxpayers file a joint return, in which case, the deduction is
reduced by the amount (if any) by which their combined income,
line 9(a) above, exceeds $6,000. This reduction does not apnly if
(a) the husband is physically or mentally incapable of caring for him-
self or (b) the wife is institutionalized for a period of at least 90 con-
secutive days (whether or not within one taxable year) or a shorter
period if terminated by her death. However, in such case enter on
the reverse side of this form: (1) the nature of disability, (2) the period of
disability, and (3) the amount, if any, of the husband's earnings during
a period when he is disabled, ig the wife is institutionalized, give
the name and location of such institution, and the exact dates she
resided in such institution,

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