OMB No. 1545-0074 Qualified Adoption Expenses Form 8839

Attach to Form 1040 or 1040A.

Department of the Treasury

Internal Revenue Service

Attachment

Sequence No. 38 See separate instructions.

Name(s) shown on return Your social security number

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

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

(b) 

Child’s year

of birth

(c) 

born before

1988 and

was disabled

1

(a) 

Child’s name

Adoption Credit

2

Did you file Form 8839 for a prior year

for the same child?

Maximum credit per child

3

3

Enter the smaller of line 4 or line 5

4

5

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

10 

Subtract line 11 from line 7

9

For Paperwork Reduction Act Notice, see page 6 of the instructions. Form 8839 (2005)

Before you begin: 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

Is line 8 more than $159,450?

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

Child

1

Child

2

Caution: If the child was a foreign child, see Special rules in the instructions for line 1, column (e), that begin on page 2, 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

Modified adjusted gross income (see page 4 of the instructions) 8

11

Subtract line 3 from line 2

12

13 Credit carryforward from prior years (line 23 of your Credit Carryforward Worksheet on

page 4 of the 2004 Form 8839 instructions)

14 Add lines 12 and 13 14

13

11

12

No. Enter -0-.

Yes. See page 4 of the instructions

for the amount to enter. 

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

Yes. Subtract $159,450 from line 8

Adoption credit. Enter the smaller of line 14 or line 17 here and on Form 1040, line 53, or

Form 1040A, line 34. If line 17 is smaller than line 14, you may have a credit carryforward

(see page 4 of the instructions)

15 Enter the amount from Form 1040, line 46, or Form 1040A, line 28

18

18

$10,630 $10,630

1040 filers: Enter the total of the amounts from Form

1040, lines 47 through 52, plus any mortgage

interest credit from Form 8396, line 11.

5

6

16

1040A filers: Enter the total of the amounts from Form

1040A, lines 29 through 33.

17 Subtract line 16 from line 15

15

16 

17

00 00

Caution: Your qualified adoption expenses

may not be equal to the adoption expenses

you paid in 2005.

2005

Before you begin: If you are filing Form 1040 and claiming the mortgage interest credit (for holders of qualified mortgage

credit certificates issued by state or local governmental units or agencies), complete Form 8396, Mortgage Interest Credit.

Qualified adoption expenses (see page 4

of the instructions)
Form 8839 (2005) Page 2

Employer-Provided Adoption Benefits

Add the amounts on line 22

26

20

Modified adjusted gross income

(from the worksheet on page 6 of

the instructions)

Is line 26 more than $159,450?

Excluded benefits. Subtract line 29 from line 25 30

31

Part III

27

Printed on recycled paper

Employer-provided adoption benefits

you received in 2005. This amount

should be shown in box 12 of your

2005 Form(s) W-2 with code T

Did you receive employer-provided

adoption benefits for a prior year for

the same child?

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”

25

Multiply line 25 by line 28

26

Taxable benefits. Is line 30 more than line 23?

28

29

28 .

21

22

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

2005, enter the amount from line 21

24

29

27

You may be able to claim the adoption credit in Part II on the front of this form if either of the following applies.

23

24

22

20

Child 1 Child 2

25

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

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

23

No. Enter -0-.

Yes. See page 4 of the instructions

for the amount to enter.

Subtract line 20 from line 19

19

21



Maximum exclusion per child 19

Form 8839 (2005)

No. Skip lines 27 and 28, and

enter -0- on line 29.

Yes. Subtract $159,450 from

line 26

30

31

$10,630 $10,630 00 00

No.

Yes.

● The total adoption expenses you paid in 2005 were not fully reimbursed by your employer and the adoption

became final in 2005 or earlier.

● You adopted a child with special needs and the adoption became final in 2005.

Subtract line 30 from line 23. Also, include this amount, if more than zero, on

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

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 1040A by the amount on

Form 8839, line 31, and enter the result on line 7 of Form 1040 or 1040A. On

the line next to line 7, enter “SNE.”

TIP