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

1979 and

was disabled

1

(a) 

Child’s name

Adoption Credit—Complete this part only if the adoption was final in or before 1997.

2

Enter the total qualified adoption

expenses you paid in 1997

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

special needs)

3

3

4 Enter the smaller of line 2 or line 3

5 Add the amounts on line 4 5

3

10

Subtract line 9 from line 5. Enter the result. Then, see the instructions for the amount of credit

to enter on Form 1040, line 42, or on Form 1040A, line 24c

9

For Paperwork Reduction Act Notice, see page 4 of instructions. Form 8839 (1997)

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

8 .

(d)

a child

with special

needs

(f)

Child’s

identifying number

First Last

19

Is line 6 more than $75,000?

6

No. Skip lines 7 and 8 and enter -0- on line 9.

Yes. Subtract $75,000 from the amount on line 6 7

7

Divide line 7 by $40,000. Enter the result as a decimal (rounded to two places). Do not enter

more than “1.00”

Multiply line 5 by line 8

8

4

9

97

Check if child was—

(e)

a

foreign

child

● Eligible Child

● Employer-Provided Adoption Benefits

● Qualified Adoption Expenses

19

Child

1

Child

2

Caution: If you received employer-provided adoption benefits, complete Part III on the back next.

1997 credit carryforward, if any, to 1998 (see the instructions) 11

10

Child 1 Child 2

Enter your modified adjusted gross income (see the instructions) 6

11
Form 8839 (1997) Page 2

Employer-Provided Adoption Benefits

Add the amounts on line 13

17

13

Enter your modified adjusted gross

income (from the worksheet in the

instructions)

Is line 17 more than $75,000?

22

No. Skip lines 18–20 and enter the

amount from line 16 on line 21.

Yes. Subtract $75,000 from the

amount on line 17

Excluded benefits. Enter the smaller of line 16 or line 21

23

Part III

20

Enter the total amount of

your employer-provided adoption

benefits received in 1997. This amount

should be shown in box 13 of your

1997 W-2 form(s) with code T

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

special needs)

Divide line 18 by $40,000. Enter the result as a decimal (rounded

to two places). Do not enter more than “1.00”

18

Multiply line 16 by line 19

19

Subtract line 20 from line 16

Taxable benefits. Subtract line 22 from line 14. Also, include this amount on Form 1040,

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

22

21

20

19 3 .

14

15 Enter the smaller of line 12 or line 13

17

21

23

18

Next, complete Form 1040 through line 41 or Form 1040A through line 24b.

Then, if the total adoption expenses you paid in 1997 were not fully reimbursed by your employer AND the adoption was

final in or before 1997, you may be able to claim the adoption credit. Fill in Part II on the front of this form to see if you can.

Caution: If the eligible child is a foreign child, see the Note in the instructions for line 1, column (e), before completing this part.

14

15

13

12

Child 1 Child 2

16 Add the amounts on line 15 16