fom 2 441 Child and Dependent Care Expenses

> Attach to Form 1040.

Department of the Treasury
Internal Revenue Service (0) > See separate Instructions.

OMB No. 1545-0068

1990

Attachment
Sequence No.

Name(s) shown on Form 1040

Your social security number

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

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

@ 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.

[Part 1] Persons or Organizations Who Provided the Care—You must complete this part. (See the Instructions. If you

need more space, attach a statement.)

(b) Address (c) eee jing number (d) Amount paid
1 (a) Name (number, street, city, state, and ZIP code) No orEIN) (See Instructions)
2 Add the amounts in column (d) of line landenterthetota. . 2. . see Lz

Note: /f you paid cash wages of $50 or more in a calendar quarter to an individual for services s performed i in your home, you must file

an employment tax return. Get Form 942 for details.

Credit for Child and Dependent Care Expenses

3 Enter the number of qualifying persons who were cared for in 1990. (See the Instructions for the definition of qualifying
persons.) Caution: To qualify, the person(s) must have shared the same home with youin1990 . . et
4 Enter the amount of qualified expenses you incurred and actually paid in 1990. See the Instructions to
find out which expenses qualify. Caution: /f you completed F Part lil on page 2, do not include on this line
any excluded benefits shown on line 25 Aan oe A
5 Enter $2,400 Sad 800 if you paid for the care of two or more ausiyng
persons) . . 5
6 Ifyou competed F Part Ill on page 2, enter the excluded benefits, if any, YW)
fromline 25. toe : 6 Vs
7__ Subtract line 6 from line 5 and enter the result. tea the result is zero or less, skip lines 8 through 1 13.
“Enter zero on line 14, and go to line 15.) : 7
8 Compare the amounts on lines 4 and 7. Enter the ‘smaller of the two ‘amounts here . . . . 8
9 You must enter your earned Income. (See the Instructions for the definition of earned income. ). . 9
10 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 forthe amounttoenter.). . . . . . 10
11 If you are married filing a joint return, compare the amounts on lines 9 and 10. Enter the smaller of 7
the two amountshere . . some A
12. e@ If you are married filing a joint return, compare the amounts
on lines 8 and 11. Enter the smaller ofthetwoamountshere. | |, Ld
@ All others, compare the amounts on lines 8 and 9. Enter
the smaller of the two amounts here.
13 Enter the decimal amount from the table below that applies to to the adjusted gross income on Form
1040,line32. 0 2 Fo tee ee LAB x
If line 32 is: Decimalamountis: If line 32 is: Decimal amount is:
Over— But not Over— But not
over—
30 $20,000—22,000 24
29 22,000—24,000 23
28 24,001 122
27 26,000: 21
16,000—18,000 26 28,000 .20
18,000—20,000 25
14 Multiply the amount on line 12 by the decimal amount on line 13 andenterthe result . . . . . [14
15 Multiply any child and dependent care expenses for 1989 that you paid in 1990 by the decimal
amount that applies to the adjusted gross income on your 1989 Form 1040, line 32, or Form 1040A,
line 14, Enter the result. (You must complete Part | and attach a statement. See the Instructions.) . [15
16__Add the amounts on lines 14 and 15. See the Instructions for the amount of credit you can claim 16

For Paperwork Reduction Act Notice, see separate Instructions.

Form 2441 (1990)


Form 2441 (1990) Page 2

Employer-Provided Dependent Care Benefits—Complete this part only if you received employer-provided
dependent care benefits. Also, be sure to complete Part |.

17 Enter the total amount of employer-provided dependent care benefits you received for 1990. (This
amount should be shown in Box 15 of your W-2 form(s). ) Do not include amounts that were reported
to you as wages in Box 10 of Form(s) W-2 . . woe ee soe 17
18 Enter the amount forfeited, if any. Caution: See the Instructions. . . 2. 1. 1 1 ee ee 18
19 Subtract line 18 from line 17 andentertheresult . . . . oe . ps
20 Enter the total amount of qualified ¢ expenses incurred in 1990 for the care of a  uaiyng Parson.
(See the Instructions.) . . eee soe ee ee 20
21 Compare the amounts on lines 19 and 20. Enter the smaller of the twoamountshere. . . . . [22
22 You must enter your earned income. (See the Instructions for lines 9 and 10 for the definition of
earnedincome.). 2. 2 6 ew ee ee Ce ee ee PR
23 If you were married at the end of 1990, you must enter your spouse's earned income. (If your
spouse was a full-time student or disabled, see the Instructions for lines 9 and 10 for the amount to 23
enter). 2... 2. nae So ee ee .
24 e@ If you were married at the end of 1990, compare the amounts
on lines 22 and 23. Enter the smaller of the two amounts here. } . 24
@ If you were unmarried, enter the amount from line 22 here.
25 Excluded benefits. Enter here the smallest of the following:
@ The amount from line 21, or
@ The amount from line 24, or } tee 25
@ $5,000 ($2,500 if married filing a separate return).
26 = Taxable benefits. Subtract line 25 from line 19. 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 to line 7, write “DCB” . . , L26

Note: /f you are also claiming the child and dependent care credit, fill in Form 1040 through line 40. Then complete Part I! of this form.