Form 8839

Department of the Treasury 

Internal Revenue Service (99)

Qualified Adoption Expenses

▶ Attach to Form 1040 or 1040NR.

▶ Attach all required documents.

OMB No. 1545-0074

2011

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

1994 and

disabled

(d) 

a child 

with special 

needs

(e) 

a 

foreign 

child

(f) 

Child’s 

identifying number

(g) 

Check if 

adoption 

became final in 

2011 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 2011.

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 $185,210?

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

Yes. Subtract $185,210 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. This is your Adoption Credit. Include this amount on Form 1040, 

line 71, or Form 1040NR, line 67. Check box b on that line and attach all required

documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 22843L Form 8839 (2011) 

▶ See separate instructions.
Form 8839 (2011) Page 2 

Part III Employer-Provided Adoption Benefits

Caution: Before completing Part III, ensure that your employer has a written qualified adoption assistance 

program.

 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 2011. 

This amount should be shown 

in box 12 of your 2011 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 2011, 

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 $185,210?

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

on line 22.

Yes. Subtract $185,210 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 2010, those expenses were not fully reimbursed by your employer or otherwise, and 

the adoption was not final by the end of 2010. 

• The total adoption expenses you paid in 2011 were not fully reimbursed by your employer or otherwise, and the 

adoption became final in 2011 or earlier. 

• You adopted a child with special needs and the adoption became final in 2011.

Form 8839 (2011)