OMB No. 1545-1552 Qualified Adoption Expenses Form 8839

 Attach to Form 1040 or 1040A.

Department of the Treasury

Internal Revenue Service

Attachment

 See separate instructions. Sequence No. 38

Name(s) shown on return Your social security number

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

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

(b) 

Child’s year

of birth

(c) 

born before

1981 and

was disabled

1

(a) 

Child’s name

Adoption Credit

2

Did you file a 1997 or 1998 Form 8839?

Enter $5,000 ($6,000 for a child with special

needs) 

3

3

Enter the smaller of line 4 or line 5

4

5

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

10 

Subtract line 11 from line 7

9

For Paperwork Reduction Act Notice, see page 4 of instructions. Form 8839 (1999)

Before you begin, you need to understand the following terms. See Definitions on page 1 of the instructions.

Cat. No. 22843L

Part I

Part II

2

.

(d)

a child

with special

needs

(f)

Child’s

identifying number

First Last

19

If line 8 is $75,000 or less, skip lines 9 and 10 and enter -0- on

line 11. If line 8 is over $75,000, subtract $75,000 from the amount

on line 8

6

9

7

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”

Multiply line 7 by line 10

8

4

Check if child was—

(e)

a

foreign

child

● Eligible Child ● Employer-Provided Adoption Benefits ● Qualified Adoption Expenses

19

Child

1

Child

2

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.

10

Child 1 Child 2

Enter your modified adjusted gross income (see instructions) 8

11

Subtract line 3 from line 2

Enter the total qualified adoption

expenses you paid in:

5

6

12

13 Enter any credit carryforward from 1997 (line 15 of your 1998 Form 8839)

Add lines 12, 13, and 14. Then, see the instructions for the amount of credit to enter on Form

1040, line 45, or Form 1040A, line 30

1997 credit carryforward to 2000 (see instructions)

1998 credit carryforward to 2000 (see instructions)

15

16

17

16

15

13

17

11

12

No. Enter -0-.

Yes. See the instructions for the

amount to enter.

● 1998 if the adoption was not final by the

end of 1999.

● 1998 and 1999 if the adoption was final

in 1999.

● 1999 if the adoption was final before

1999.





1999

14 Enter any credit carryforward from 1998 (line 16 of your 1998 Form 8839) 14

18 1999 credit carryforward to 2000 (see instructions) 18
Form 8839 (1999) Page 2

Employer-Provided Adoption Benefits

Add the amounts on line 22

26

22

Enter your modified adjusted gross

income (from the worksheet in the

instructions)

If line 26 is $75,000 or less, skip

lines 27 and 28 and enter -0- on line

29. If line 26 is over $75,000,

subtract $75,000 from the amount

on line 26

Excluded benefits. Subtract line 29 from line 25 30

31

Part III

29

Enter the total amount of your

employer-provided adoption benefits

received in 1999. This amount should be

shown in box 13 of your 1999 W-2 form(s)

with code T 

20 Did you receive employer-provided

adoption benefits for 1997 or 1998?

Divide line 27 by $40,000. Enter the result as a decimal (rounded

to at least three places). Do not enter more than “1.000”

27

Multiply line 25 by line 28

28

Taxable benefits. Subtract line 30 from line 23. Also, include this amount on Form 1040,

line 7, or Form 1040A, line 7. On the line next to line 7, enter “AB”

30

29

28  .

23

24 Enter the smaller of line 21 or line 22

26

31

27

If the total adoption expenses you paid in 1999 were not fully reimbursed by your employer AND the adoption was final in

or before 1999, you may be able to claim the adoption credit in Part II on the front of this form.

23

24

22

20

Child 1 Child 2

25

Add the amounts on line 24. If zero, skip lines 26-29, enter -0- on

line 30, and go to line 31

25

No. Enter -0-.

Yes. See the instructions for the

amount to enter.

Subtract line 20 from line 19. If zero or

less, enter -0-

21

21



19 Enter $5,000 ($6,000 for a child with

special needs) 19

Form 8839 (1999)