Form 8839 Qualified Adoption Expenses

Caution: DRAFT FORM
This is an advance proof copy of an IRS tax form.
It is subject to change and OMB approval before it
is officially released. You can check the scheduled
release date on our web site (www.irs.gov).
If you have any comments on this draft form, you can
submit them to us on our web site. Include the word
DRAFT in your response. You may make comments
anonymously, or you may include your name and
e-mail address or phone number. We will be unable
to respond to all comments due to the high volume
we receive. However, we will carefully consider
each suggestion. So that we can properly consider
your comments, please send them to us within 30
days from the date the draft was posted.

Form

8839

Qualified Adoption Expenses
© Attach

Department of the Treasury
Internal Revenue Service (99)
Name(s) shown on return

Before you begin

Part I

© See

OMB No. 1545-0074

2009

to Form 1040 or 1040NR.
separate instructions.

Attachment
Sequence No. 38
Your social security number

f
o
s
a
9
t
0
f
0
a
2
r
/
D /14
7
0

✓ 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.

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.
Check if child was—

(a)
Child’s name

1
First
Child
1
Child
2

(b)
Child’s year
of birth

(c)
(d)
born before
a child
1992 and with special
disabled
needs

Last

(e)
a
foreign
child

(f)
Child’s
identifying number

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.

Part II

Adoption Credit

Child 2

Child 1

2
3

Maximum adoption credit per child . . .
Did you file Form 8839 for a prior year for
the same child?
No. Enter -0-.
Yes. See page 3 of the instructions for
the amount to enter.
Subtract line 3 from line 2 . . . . . .
Qualified adoption expenses (see page 3
of the instructions) . . . . . . . . .
Caution. Your qualified adoption expenses may not
be equal to the adoption expenses you paid in 2009.

%

4
5

6
7
8
9

10
11
12
13
14
15
16

17
18

2

$12,150

00

$12,150

00

3
4
5

Enter the smaller of line 4 or line 5 . . .
6
Add the amounts on line 6. If zero, skip lines 8 through 11 and enter -0- on line 12 . . . . .
8
Modified adjusted gross income (see page 3 of the instructions) .
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
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 . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 11 from line 7 . . . . . . . . . . . . . . . . . . . . . . .
Credit carryforward from prior years (line 23 of your Credit Carryforward Worksheet on page 5
of the 2008 Form 8839 instructions) . . . . . . . . . . . . . . . . . . . .
Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . .
15
Enter the amount from Form 1040, line 46, or Form 1040NR, line 43
1040
Enter the total of any amounts from Form 1040, lines 47 through 50;
filers: Form 5695, line 11; and line 12 of the Line 11 Worksheet in Pub. 972
(see page 3 of the instructions); Form 8396, line 11; Form 8834, line
22; Form 8910, line 21; Form 8936, line 14; and Schedule R, line 24.
16
1040NR 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
filers:
Pub. 972 (see page 3 of the instructions); Form 8396, line 11; Form
8834, line 22; Form 8910, line 21; and Form 8936, line 14.

7

10
11
12

3

.

13
14

%

Subtract line 16 from line 15
. . . . . . . . . . . . . . . . . . . . . .
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 5 of the instructions) . . . . . . . . . . . . .

For Paperwork Reduction Act Notice, see page 6 of the instructions.

Cat. No. 22843L

17

18
Form 8839 (2009)

Page 2

Form 8839 (2009)

Part III

Employer-Provided Adoption Benefits
Child 1

f
o
s
%
a
9
t
0
f
0
a
2
r
/
D /14
7
0

19

Maximum exclusion per child

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

21
22

.

.

.

.

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 . . . . . . . .

.

.

.

.

.

00

$12,150

00

20

21

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

$12,150

19

.

23

25

Child 2

22

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

23

24

Add the amounts on line 24. If zero, skip lines 26 through 29, enter
-0- on line 30, and go to line 31 . . . . . . . . . . .

25

Modified adjusted gross income (from
the worksheet on page 6 of the
26
instructions) . . . . . . . . .
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
27
26 . . . . . . . . . . .
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

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

26

27

28

.

.

.

.

.

.

.

.

.

.

3

.

.

.

.

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)