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

2009

Attachment 

Sequence No. 38

Name(s) shown on return Your social security number

Before you begin ✓ Figure the amounts of any of the following credits you are claiming: credit for the elderly or the disabled, nonbusiness energy property 

credit, qualified plug-in electric vehicle credit, alternative motor vehicle credit, and qualified plug-in electric drive motor vehicle credit. 

✓ See Definitions on page 1 of the instructions.

Part I Information About Your Eligible Child or Children—You must complete this part. See page 2 and 3 of the

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

1

(a) 

Child’s name

First Last

(b) 

Child’s year 

of birth

Check if child was—

(c) 

born before

1992 and

disabled

(d) 

a child 

with special 

needs

(e) 

a 

foreign 

child

(f) 

Child’s 

identifying number

Child 

1

Child 

2

Caution. If the child was a foreign child, see Special rules in the instructions for line 1, column (e) on page 3, 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

2 Maximum adoption credit per child . . . 2 $12,150 00 $12,150 00

3 Did you file Form 8839 for a prior year for 

the same child?

No. Enter -0-.

Yes. See page 4 of the instructions for 

the amount to enter. % 3 

4 Subtract line 3 from line 2 . . . . . . 4 

5 Qualified adoption expenses (see page 4

of the instructions) . . . . . . . . . 5 

Caution. Your qualified adoption expenses may not 

be equal to the adoption expenses you paid in 2009.

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 Modified adjusted gross income (see page 5 of the instructions) . 8 

9 Is line 8 more than $182,180?

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

Yes. Subtract $182,180 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 3 .

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 2008 Form 8839 instructions) . . . . . . . . . . . . . . . . . . . . 13 

14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . . 14 

15 Enter the amount from Form 1040, line 46, or Form 1040NR, line 43 15 

16 1040 

filers:

Enter the total of any amounts from Form 1040, lines 47 through 50; 

Form 5695, line 11; and line 12 of the Line 11 Worksheet in Pub. 972 

(see page 5 of the instructions); Form 8396, line 11; Form 8834, line 

22; Form 8910, line 21; Form 8936, line 14; and Schedule R, line 24.

1040NR 

filers:

Enter the total of any amounts from Form 1040NR, lines 44 through 

46; Form 5695, line 11; and line 12 of the Line 11 Worksheet in 

Pub. 972 (see page 5 of the instructions); Form 8396, line 11; Form 

8834, line 22; Form 8910, line 21; and Form 8936, line 14.

% 16 

17 Subtract line 16 from line 15 . . . . . . . . . . . . . . . . . . . . . . 17 

18 Adoption credit. Enter the smaller of line 14 or line 17 here and include on Form 1040, line 52, 

or Form 1040NR, line 48. Check box b on that line. If line 17 is smaller than line 14, you may

have a credit carryforward (see page 6 of the instructions) . . . . . . . . . . . . . 18 

For Paperwork Reduction Act Notice, see page 6 of the instructions. Cat. No. 22843L Form 8839 (2009) 
Form 8839 (2009) Page 2 

Part III Employer-Provided Adoption Benefits

Child 1 Child 2

19 Maximum exclusion per child . . . . . 19 $12,150 00 $12,150 00

20 Did you receive employer-provided 

adoption benefits for a prior year for the 

same child?

No. Enter -0-.

Yes. See page 6 of the instructions for 

the amount to enter. % 20 

21 Subtract line 20 from line 19 . . . . . 21 

22 Employer-provided adoption benefits you 

received in 2009. This amount should be 

shown in box 12 of your 2009 Form(s) W-2 

with code T . . . . . . . . . . . 22 

23 Add the amounts on line 22 . . . . . . . . . . . . . . . . . . . . . . . 23 

24 Enter the smaller of line 21 or line 22. But if 

the child was a child with special needs and 

the adoption became final in 2009, enter the 

amount from line 21 . . . . . . . . 24 

25 Add the amounts on line 24. If zero, skip lines 26 through 29, enter 

-0- on line 30, and go to line 31 . . . . . . . . . . . 25 

26 Modified adjusted gross income (from 

the worksheet on page 6 of the 

instructions) . . . . . . . . . 26 

27 Is line 26 more than $182,180?

No. Skip lines 27 and 28, and 

enter -0- on line 29.

Yes. Subtract $182,180 from line 

26 . . . . . . . . . . . 27 

28 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 . . . . . 28 3 .

29 Multiply line 25 by line 28 . . . . . . . . . . . . . 29 

30 Excluded benefits. Subtract line 29 from line 25 . . . . . . . . . . . . . . . . 30 

31 Taxable benefits. Is line 30 more than line 23?

No. Subtract line 30 from line 23. 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 23 from line 30. 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 31. 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.

% . . 31 

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 2008, those expenses were not fully reimbursed by your employer or otherwise, and 

the adoption was not final by the end of 2008. 

● The total adoption expenses you paid in 2009 were not fully reimbursed by your employer or otherwise, and the 

adoption became final in 2009 or earlier. 

● You adopted a child with special needs and the adoption became final in 2009.

Form 8839 (2009)