Form 8839

Department of the Treasury 

Internal Revenue Service (99)

Qualified Adoption Expenses

▶ Attach to Form 1040 or 1040NR.

OMB No. 1545-0074

2012

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

1995 and

disabled

(d) 

a child 

with special 

needs

(e) 

a 

foreign 

child

(f) 

Child’s 

identifying number

(g) 

Check if 

adoption 

became final in 

2012 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 2012.

5 

6 Enter the smaller of line 4 or line 5 6 

7 Enter modified adjusted gross income (see instructions) . . . . . . 7

8 Is line 7 more than $189,710?

No. Skip lines 8 and 9, and enter -0- on line 10.

Yes. Subtract $189,710 from line 7 . . . . . . . . . . . 8

9 Divide line 8 by $40,000. Enter the result as a decimal (rounded to at least three places). 

Do not enter more than 1.000 . . . . . . . . . . . . . . . . . . . . . . 9 × . 

10 Multiply each amount on line 6 

by line 9 . . . . . . . 10

11 Subtract line 10 from line 6 . 11

12 Add the amounts on line 11, then see the instructions for the amount of Adoption Credit to 

enter here and on Form 1040, line 53, or Form 1040NR, line 50. Check box c on that line and 

enter "8839" in the space next to box c . . . . . . . . . . . . . . . . . . . 12

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 22843L Form 8839 (2012) 

▶ For information about Form 8839 and its separate instructions, see www.irs.gov/form8839.
Form 8839 (2012) Page 2 

Part III Employer-Provided Adoption Benefits

 Child 1 Child 2 Child 3 

13 Maximum exclusion per child 13

14 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. } 14

15 Subtract line 14 from line 13 15

16 Employer-provided adoption 

benefits you received in 2012. 

This amount should be shown 

in box 12 of your 2012 Form(s) 

W-2 with code T . . . . 16

17 Add the amounts on line 16 . . . . . . . . . . . . . . . .

 . . . . . . . 17

18 

 

 

 

Enter the smaller of line 15 or 

line 16. But if the child was a 

child with special needs and the 

adoption became final in 2012, 

enter the amount from line 15 18

19 Enter modified adjusted gross income (from 

the worksheet in the instructions) . . . . 19

20 Is line 19 more than $189,710?

No. Skip lines 20 and 21, and enter -0- 

on line 22.

Yes. Subtract $189,710 from line 19 20

21 Divide line 20 by $40,000. Enter the result as a decimal (rounded to 

at least three places). Do not enter more than 1.000 . . . . . 21 × . 

22 Multiply each amount on line 18 

by line 21 . . . . . . . 22

23 Excluded benefits. Subtract 

line 22 from line 18 . . . . 23

24 Add the amounts on line 23 . . . . . . . . . . . . . . . . . . . . . . . 24

25 Taxable benefits. Is line 24 more than line 17?

No. Subtract line 24 from line 17. 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 17 from line 24. 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 25. 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.

} . . 25

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 2011, those expenses were not fully reimbursed by your employer or otherwise, and 

the adoption was not final by the end of 2011. 

• The total adoption expenses you paid in 2012 were not fully reimbursed by your employer or otherwise, and the 

adoption became final in 2012 or earlier. 

• You adopted a child with special needs and the adoption became final in 2012.

Form 8839 (2012)