com 2441 Child and Dependent Care Expenses

P Attach to Form 1040.

Department of the Treasury
Internal Revenue Service P See separate Instructions.

OMB No. 1545-0068

1989

Attachment
Sequence No. 23,

Name(s) shown on Form 1040

Your social security number

@ If you are claiming the child and dependent care credit, complete Parts | and I! below. But if you received employer-provided

dependent care benefits, first complete Part Ill on the back.

e If you are not claiming the credit but you received employer-provided dependent care benefits, only complete Part |, below, and

Part Ill on the back.

Persons or Organizations Who Provided the Care—You must complete this part. (See the Instructions. If you

need more space, attach a statement.)

1 (a) Name (b) Address (c) Identification number, (d) Amount paid
(number, street, city, state, and ZIP code) (SSN or EIN) (see Instructions)
2 Add the amounts in column (d) of line 1 and enter the total . l 2
Note: If you paid cash wages of $50 or more in a calendar quarter toa an individual for services ‘performed i in your home, you must file
an employment tax return. Get Form 942 for details.
| Part 11 Credit for Child and Dependent Care Expenses
3 Enter the number of qualifying persons who were cared for in 1989. (See the Instructions for the definition of f qualifying
persons.) Caution: To qualify, the person(s) must have shared the same home with you in 1989 .
4 Enter the amount of qualified expenses you incurred and actually paid in 1989. Also see the
Instructions if you received employer-provided dependent care benefits. See What Are Qualified
Expenses? in the Instructions. Do not enter more than $2y 400 a 800 if you pald for the care of
two or more qualifying persons) . oe 4
5 Enter the excluded benefits, if any, from line 21 on page 2: 5
6 Subtract line 5 from line 4 and enter the result. If the result is zero or less, sop here; ‘you cannot
claim the credit... . §
7 You must enter your earned ir income. e. (See the Instructions forthe definition of ‘earned i income ). 7
8 If you are married filing a joint return, you must enter your spouse's earned income. (If your spouse
was a full-time student or disabled, see the Instructions for the amount to enter.) . toe 8
9 If you are married filing a joint return, compare the amounts on lines 7 and 8. Enter the smaller of
the two amounts here . : 9
10 e If you are married filing a joint return, compare the amounts on
lines 6 and 9. Enter the smaller of the two amounts here. 10
@ All others, compare the amounts on lines 6 and 7. Enter
the smaller of the two amounts here.
11 Enter the decimal amount from the table below that applies to the © adjusted Bross income on Form
1040,line32. 2. 2 2 1 we oe see) Lad x
Ifline 32 Decimal amount If tine 3: Decimal amount is:
Over— But not Over— Butnot
over— over—
$0—10,000 30 $20,000—22,000 24
10,000—12,000 29 22,000—24,000 23
12,000—14,000 28 24,000—26,000 22
14/000—16,000 27 26,000—28,000 21
16,000—18,000 26 28,000 .20
18,000—20,000 25
12 Multiply the amount on line 10 by the decimal amount on line 11, and enter the result 12
13 Multiply any child and dependent care expenses for 1988 that you paid in 1989 by the percentage
that applies to the adjusted gross income on your 1988 Form 1040, line 32, or Form 1040A, line 14.
Enter the result. (You must complete Part | and attach a statement. See the Instructions.) . 13
14 Add the amounts on lines 12 and 13. See the Instructions for the amount of credit you can claim _. 14

For Paperwork Reduction Act Notice, see separate Instructions.

Form 2441 (1989)


Form 2441 (1989) Page 2

iz4ay Employer-Provided Dependent Care Benefits
Caution: Be sure to also complete Part | on page 1.

15 Enter the total amount of employer-provided dependent care benefits you received for 1989. (This
amount should be separately shown on your W-2 forms and labeled as “DCB.”) Do not include

amounts that were reported to you as wages in Box 10 of Form(s)W-2.. . . . rn 15
16 Enter the total amount of qualified expenses incurred in 1989 for the care of a  caliing person

(see the Instructions) . . . toe tone 16
17 Compare the amounts on lines 15 and 16. Enter the smaller of the twoamountshere . . . . 17
18 You must enter your earned in income. Gee the Instructions for lines 7 and 8 for the definition of

earnedincome.). . . Lo ow. [18
19 If you were married at the end of 1989, you must enter your spouse’s earned income. ‘Wh your spouse

was a full-time student or disabled, see the Instructions for lines 7 and 8 for the amount toenter.). . [19
20 @ If you were married at the end of 1989, compare the amounts on

lines 18 and 19 and enter the smaller of the two amounts here. to 20

@ Ifyou were unmarried, enter the amount from line 18 here.
21 Excluded benefits. Enter here the smallest of the following:

The amount from line 20, or 21

$5,000 ($2,500 if married filing a separate return).
22 Taxable benefits. Subtract line 21 from line 15. Enter the result, but not less than zero. Also include
this amount in the total on Form 1040, line 7. On the dotted line next toline 7, write “DCB” - - - [22

Note: If you are also claiming the child and dependent care credit, fill in Form 1040 through line 40. Then complete Part I of this form.
Be sure to include any amount shown on line 22 above when figuring your earned income in Part Il.

@ The amount from line 17, or \