9 441 Statement of Expenses for Care of Children
1. rn and Certain Other Dependents 1967

Internal Revenue Service (To Be Filed with Form 1040)

This deduction 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 woman 1 Married woman 0 Married man—wife incapacitated
1 Divorced O Married woman—husband incapacitated 0 Married man—wife institutionalized
1 Legally separated 1 Widow 0 Widower

NOTE: If you checked more than one box do not use this form. Contact any Internal Revenue Service office for further information.

3 Name of child or other dependent for whom ex- | If under 13 | If 13 years of age or over, explain reason for expenses
penses were paid years of age, (see instruction B)
please check

4 Person(s) or organization(s) to whom payments were made and amount paid to each

COMPUTATION OF DEDUCTION
5 Total amount of paid expenses, as listed in item 4. . . . .
6 Amount paid for services for the indirect care of dependent(s) listed i in item 3 (see instruction D).
7 Balance (subtract line 6 from line 5)
8 Enter the lesser of (1) the amount on line 7, or (2) $600 ($900 if two or more dependents) . .
NOTE: If your husband is capable of self-support; or, if your wife has been institutionalized for a period
of less than 90 consecutive days, see instruction C and complete line 9. Otherwise, copy the amount
shown on line 8 of this form in “Miscellaneous deductions,” Part IV, page 2 of Form 1040.
9 Limitation for certain taxpayers:
(a) Enter the amount shown on line 9, page 1, Form 1040. . . .
(b) Less. ww ee ee
(©) Balancen 2 1 ee ee ee wo ee

(d) Allowable deduction for certain taxpayers, line 8 less line 90). Enter 1 this 2 amount here and in
“Miscellaneous deductions,” Part IV, page 2 of Form 1040 . _ .

Supplemental information (see instruction G)



Instructions

A. Who May Claim This Deduction.—A single woman,
widower, or a person who is legally separated or divorced
and not remarried, may deduct expenses for the care of
certain dependents. Subject to special limitations, a mar-
ried woman; or, a husband whose wife is incapacitated or
institutionalized, may also be entitled to a deduction for
the care of certain dependents.

In general, this deduction may be claimed only if the
expense is for the purpose of enabling a taxpayer to be
gainfully employed, and it is for the care of a dependent
while the taxpayer is employed or in search of employment.

B. “Certain Dependents.”—The only dependents for
whom this 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. Amount of Deduction.—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:

(1) Single woman

(2) Widower

(3) Spouse, in instances where:

(a) the husband is physically or mentally incapable
of caring for himself, or

(b) the wife is incapacitated or institutionalized for
a period of at least 90 consecutive days or a
shorter period if terminated by death, or

(c) the wife has been deserted by her husband and
(i) at the time her return for the taxable year
is filed she does not know the whereabouts of her
husband, and (ii) has not known at any time
during the taxable year of his whereabouts, and
(iii) has applied to a court to compel her hus-
band to pay support or otherwise to comply with
the law or a judicial order.

A wife whose husband is capable of self-support is also
entitled to the same deduction, reduced by the amount (if
any) that their combined income, line 9(a) of this form,
exceeds $6,000. This same reduction also applies to a hus-
band whose wife is institutionalized for a period of less than

‘¢ US. GOVERNMENT PRINTING OFFICE : 1967-~O-260-094

90 consecutive days, regardless of the period (in excess of
90 days) that she is physically or mentally incapable of
caring for herself.

D. Expenses.—Expenses for the care of a dependent
are amounts paid for the primary purpose of assuring the
dependent’s well being and protection. They do not neces-
sarily include all benefits which may be bestowed upon
the dependent; for example, food, clothing, or education
are not in themselves amounts expended for “care” so as
to be deductible.

However, where the manner of providing care must in-
clude payments for other benefits which are inseparably a
part of such care the full amount will be considered to be
incurred for care. For example, amounts paid to a nursery
school will be considered to be for the care of the child
even though the school also furnished lunch; also, in those
cases where you pay a person to do both housework and
take care of a dependent, only that part of the expenses
which is for the dependent’s care qualifies for the deduction.

Amounts which you pay to a dependent for the care of
another dependent are not deductible.

E. Expenses Must Be Paid.—Expenses for such care
must have been paid during the taxable year regardless of
when incurred.

F. Joint Return.—A joint return is required to be filed
by married taxpayers who claim this deduction. However,
a wife who has been deserted by her husband may claim
this deduction on a separate return.

G. Required Supplemental Information.—If cither
spouse is mentally or physically incapable of self-care enter
the following information in the blank space on the reverse
side:

(1) the nature of the disability,

(2) the period of the disability, and if applicable,

(3) the amount of the husband’s earnings during the

period of his disability.

If your wife was or is institutionalized for a period of at
least 90 consecutive days, also give the name and location
of such institution, and exact dates she lived there.

16—70820-1