Form 8839

Department of the Treasury 

Internal Revenue Service (99)

Qualified Adoption Expenses

▶ Attach to Form 1040 or 1040NR.

▶ See separate instructions.

OMB No. 1545-0074

2010

Attachment 

Sequence No. 38

Name(s) shown on return Your social security number

Part I Information About Your Eligible Child or Children—You must complete this part. See instructions for 

details, including what to do if you need more space.

1

(a) 

Child’s name (b) 

Child’s year 

of birth

Check if child was—

(c) 

born before

1993 and

disabled

(d) 

a child 

with special 

needs

(e) 

a 

foreign 

child

(f) 

Child’s 

identifying number

(g) 

Check if 

adoption 

became final in 

2010 or earlier First Last 

Child 

1

Child 

2

Child 

3

Caution. If the child was a foreign child, see Special rules in the instructions for line 1, column (e) before you complete Part II or 

Part III. If you received employer-provided adoption benefits, complete Part III on the back next.

Part II Adoption Credit

Child 1 Child 2 Child 3 

2 Maximum adoption credit per 

child . . . . . . . . 2 

3 Did you file Form 8839 for a 

prior year for the same child?

No. Enter -0-.

Yes. See instructions for 

the amount to enter. } 3 

4 Subtract line 3 from line 2 . 4 

5 Qualified adoption expenses 

(see instructions) . . . .

Caution. Your qualified 

adoption expenses may not be 

equal to the adoption expenses 

you paid in 2010.

5 

6 Enter the smaller of line 4 or line 5 6 

7 Add the amounts on line 6. If zero, skip lines 8 through 11 and enter -0- on line 12 . . . . . 7 

8 Enter modified adjusted gross income (see instructions) . . . . 8 

9 Is line 8 more than $182,520?

No. Skip lines 9 and 10, and enter -0- on line 11.

Yes. Subtract $182,520 from line 8 . . . . . . . . . 9 

10 Divide line 9 by $40,000. Enter the result as a decimal (rounded to at least three places). 

Do not enter more than 1.000 . . . . . . . . . . . . . . . . . . . . . . 10 × .

11 Multiply line 7 by line 10 . . . . . . . . . . . . . . . . . . . . . . . . 11 

12 Subtract line 11 from line 7 . . . . . . . . . . . . . . . . . . . . . . . 12 

13 Credit carryforward from prior years (line 23 of your Credit Carryforward Worksheet on page 5

of the 2009 Form 8839 instructions) . . . . . . . . . . . . . . . . . . . . 13 

14 Add lines 12 and 13. This your Adoption Credit. Include this amount on Form 1040, line 71, or 

Form 1040NR, line 66. Check box b on that line . . . . . . . . . . . . . . . . 14 

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 22843L Form 8839 (2010) 
Form 8839 (2010) Page 2 

Part III Employer-Provided Adoption Benefits

 Child 1 Child 2 Child 3 

15 Maximum exclusion per child 15 

16 Did you receive employerprovided adoption benefits for a 

prior year for the same child?

No. Enter -0-.

Yes. See instructions for 

the amount to enter. } 16

17 Subtract line 16 from line 15 17

18 Employer-provided adoption 

benefits you received in 2010. 

This amount should be shown 

in box 12 of your 2010 Form(s) 

W-2 with code T . . . . 18

19 Add the amounts on line 18 . . . . . . . . . . . . . . . . . . . . . . . 19

20 Enter the smaller of line 17 or 

line 18. But if the child was a 

child with special needs and the 

adoption became final in 2010, 

enter the amount from line 17 20

21 Add the amounts on line 20. If zero, skip lines 22 through 25, enter 

-0- on line 26, and go to line 27 . . . . . . . . . . . 21

22 Enter modified adjusted gross income 

(from the worksheet in the instructions) 22 

23 Is line 22 more than $182,520?

No. Skip lines 23 and 24, and 

enter -0- on line 25.

Yes. Subtract $182,520 from line 

22 . . . . . . . . . . . 23 

24 Divide line 23 by $40,000. Enter the result as a decimal (rounded to 

at least three places). Do not enter more than 1.000 . . . . . 24 × .

25 Multiply line 21 by line 24 . . . . . . . . . . . . . 25 

26 Excluded benefits. Subtract line 25 from line 21 . . . . . . . . . . . . . . . . 26

27 Taxable benefits. Is line 26 more than line 19?

No. Subtract line 26 from line 19. Also, include this amount, if more than zero, on 

line 7 of Form 1040 or line 8 of Form 1040NR. On the dotted line next to line 

7 of Form 1040 or line 8 of Form 1040NR, enter “AB.”

Yes. Subtract line 19 from line 26. Enter the result as a negative number. Reduce 

the total you would enter on line 7 of Form 1040 or line 8 of Form 1040NR by

the amount on Form 8839, line 27. Enter the result on line 7 of Form 1040 or 

line 8 of Form 1040NR. Enter “SNE” on the dotted line next to the entry line.

} . . 27

TIP

You may be able to claim the adoption credit in Part II on the front of this form if any of the following apply. 

• You paid adoption expenses in 2009, those expenses were not fully reimbursed by your employer or otherwise, and 

the adoption was not final by the end of 2009. 

• The total adoption expenses you paid in 2010 were not fully reimbursed by your employer or otherwise, and the 

adoption became final in 2010 or earlier. 

• You adopted a child with special needs and the adoption became final in 2010.

Form 8839 (2010)