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

1982 and

was disabled

1

(a) 

Child’s name

Adoption Credit

2

Did you file a 1997, 1998, or 1999

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 (2000)

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

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

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 Carryforward of adoption credit to 2000 (see instructions)

Add lines 12 and 13. Then, see the instructions for the amount of credit to enter on Form 1040,

line 48, or Form 1040A, line 31

14

14

13

11

12

No. Enter -0-.

Yes. See the instructions for the

amount to enter.

● 1999 if the adoption was not final by the

end of 2000.

● 1999 and 2000 if the adoption was final

in 2000.

● 2000 if the adoption was final before

2000.





2000
Form 8839 (2000) Page 2

Employer-Provided Adoption Benefits

Add the amounts on line 18

22

18

Enter your modified adjusted gross

income (from the worksheet in the

instructions)

If line 22 is $75,000 or less, skip

lines 23 and 24 and enter -0- on line

25. If line 22 is over $75,000,

subtract $75,000 from the amount

on line 22

Excluded benefits. Subtract line 25 from line 21 26

27

Part III

25

Enter the total amount of your

employer-provided adoption benefits

received in 2000. This amount should be

shown in box 13 of your 2000 W-2 form(s)

with code T 

16 Did you receive employer-provided

adoption benefits for 1997, 1998, or

1999?

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”

23

Multiply line 21 by line 24

24

Taxable benefits. Subtract line 26 from line 19. Also, include this amount on Form 1040,

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

26

25

24  .

19

20 Enter the smaller of line 17 or line 18

22

27

23

If the total adoption expenses you paid in 2000 were not fully reimbursed by your employer and the adoption was final in or

before 2000, you may be able to claim the adoption credit in Part II on the front of this form.

19

20

18

16

Child 1 Child 2

21

Add the amounts on line 20. If zero, skip lines 22-25, enter -0- on

line 26, and go to line 27

21

No. Enter -0-.

Yes. See the instructions for the

amount to enter.

Subtract line 16 from line 15. If zero or

less, enter -0-

17

17



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

special needs) 15

Form 8839 (2000)