Form 8839 Qualified Adoption Expenses

Form

8839

Qualified Adoption Expenses
▶

Department of the Treasury
Internal Revenue Service (99)

OMB No. 1545-0074

2010

Attach to Form 1040 or 1040NR.
▶ See separate instructions.

Attachment
Sequence No. 38
Your social security number

Name(s) shown on return

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.
Check if child was—

(a)
Child’s name

1
First

(b)
Child’s year
of birth
Last

(c)
(d)
born before
a child
1993 and with special
disabled
needs

(f)
Child’s
identifying number

(e)
a
foreign
child

(g)
Check if
adoption
became final in
2010 or earlier

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

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 instructions for
the amount to enter.
Subtract line 3 from line 2 .
Qualified adoption expenses
(see instructions) . . . .

}

4
5

6
7
8
9

10
11
12
13
14

2

$13,170

Child 2

00

$13,170

Child 3

00

$13,170

00

3
4
5

Caution.
Your
qualified
adoption expenses may not be
equal to the adoption expenses
you paid in 2010.
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 . . . . .
Enter modified adjusted gross income (see instructions) . . . .
8
Is line 8 more than $182,520?
No. Skip lines 9 and 10, and enter -0- on line 11.
9
Yes. Subtract $182,520 from line 8 . . . . . . . . .
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 2009 Form 8839 instructions) . . . . . . . . . . . . . . . . . . . .
Add lines 12 and 13. This your Adoption Credit. Include this amount on Form 1040, line 71, or
Form 1040NR, line 66. Check box b on that line . . . . . . . . . . . . . . . .

For Paperwork Reduction Act Notice, see your tax return instructions.

Cat. No. 22843L

7

10
11
12

×

.

13
14

Form 8839 (2010)

Page 2

Form 8839 (2010)

Part III

Employer-Provided Adoption Benefits
Child 1

15

Maximum exclusion per child

16

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.
Subtract line 16 from line 15

}

17
18

Add the amounts on line 18 .

20

Enter the smaller of line 17 or
line 18. But if the child was a
child with special needs and the
adoption became final in 2010,
enter the amount from line 17

.

00

Child 3

$13,170

00

$13,170

17

18
.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

21

Enter modified adjusted gross income
(from the worksheet in the instructions)
22
Is line 22 more than $182,520?
No. Skip lines 23 and 24, and
enter -0- on line 25.
Yes. Subtract $182,520 from line
22 . . . . . . . . . . .
23
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 . . . . .

24

25

Multiply line 21 by line 24

.

.

.

.

.

.

25

26

Excluded benefits. Subtract line 25 from line 21 .

.

.

.

.

.

27

Taxable benefits. Is line 26 more than line 19?
No. Subtract line 26 from line 19. 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 19 from line 26. 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 27. 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.

23

24

.

.

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19

.

.

26

.

.

27

.

20

Add the amounts on line 20. If zero, skip lines 22 through 25, enter
-0- on line 26, and go to line 27 . . . . . . . . . . .

22

00

16

Employer-provided
adoption
benefits you received in 2010.
This amount should be shown
in box 12 of your 2010 Form(s)
W-2 with code T . . . .

19

21

$13,170

15

Child 2

.

.

.

.

.

.

.

.

×

.

.

.

.

.

.

}

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

TIP

• You paid adoption expenses in 2009, those expenses were not fully reimbursed by your employer or otherwise, and
the adoption was not final by the end of 2009.
• The total adoption expenses you paid in 2010 were not fully reimbursed by your employer or otherwise, and the
adoption became final in 2010 or earlier.
• You adopted a child with special needs and the adoption became final in 2010.
Form 8839 (2010)