Form 8839 Qualified Adoption Expenses

Form

8839

Department of the Treasury
Internal Revenue Service (99)

Qualified Adoption Expenses
▶

OMB No. 1545-0074

2013

▶ Attach to Form 1040 or 1040NR.
For information about Form 8839 and its separate instructions, see www.irs.gov/form8839.

Your social security number

Name(s) shown on return

Part I

Attachment
Sequence No. 38

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
1996 and with special
disabled
needs

(f)
Child’s
identifying number

(e)
a
foreign
child

(g)
Check if
adoption
became final in
2013 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
15
16

2

$12,970

Child 2

00

$12,970

Child 3

00

$12,970

00

3
4
5

Caution.
Your
qualified
adoption expenses may not be
equal to the adoption expenses
you paid in 2013.
Enter the smaller of line 4 or line 5
6
Enter modified adjusted gross income (see instructions) . . . . . .
7
Is line 7 more than $194,580?
No. Skip lines 8 and 9, and enter -0- on line 10.
Yes. Subtract $194,580 from line 7 . . . . . . . . . . .
8
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 . . . . . . . . . . . . . . . . . . . . . .
Multiply each amount on line 6
by line 9 . . . . . . .
10
Subtract line 10 from line 6 .
11
Add the amounts on line 11 . . . . . . . . . . . . . . . . . . . . . . .
Credit carryforward, if any, from 2012. See the 2012 to 2013 Credit Carryforward Worksheet in
the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . .
Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . .
Enter the amount from line 5 of the Credit Limit Worksheet in the instructions . . . . . .
Adoption Credit. Enter the smaller of line 14 or line 15 here and on Form 1040, line 53, or Form
1040NR, line 50. Check box c on that line and enter “8839” in the space next to box c. If line 15
is smaller than line 14, you may have a credit carryforward (see instructions) . . . . . . .

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

Cat. No. 22843L

9

×

.

12
13
14
15

16
Form 8839 (2013)

Page 2

Form 8839 (2013)

Part III

Employer-Provided Adoption Benefits
Child 1

17

Maximum exclusion per child

18

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 18 from line 17

}

19
20

$12,970

17

Child 2

00

$12,970

Employer-provided adoption
benefits you received in 2013.
This amount should be shown
in box 12 of your 2013 Form(s)
W-2 with code T . . . .

Enter the smaller of line 19 or
line 20. But if the child was a
child with special needs and the
adoption became final in 2013,
enter the amount from line 19
22
Enter modified adjusted gross income (from
the worksheet in the instructions) . . . .
23
Is line 23 more than $194,580?
No. Skip lines 24 and 25, and enter -0on line 26.
24
Yes. Subtract $194,580 from line 23
Divide line 24 by $40,000. Enter the result as a decimal (rounded to
at least three places). Do not enter more than 1.000 . . . . .
Multiply each amount on line 22
by line 25 . . . . . . .
26
Excluded benefits. Subtract
line 26 from line 22 . . . .
27

26
27

00

20

22

25

$12,970

19

Add the amounts on line 20 .

24

00

18

21

23

Child 3

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×

25

28

Add the amounts on line 27 .

29

Taxable benefits. Is line 28 more than line 21?
No. Subtract line 28 from line 21. 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 21 from line 28. 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 29. 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.

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21

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28

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29

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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 2012, those expenses were not fully reimbursed by your employer or otherwise, and
the adoption was not final by the end of 2012.
• The total adoption expenses you paid in 2013 were not fully reimbursed by your employer or otherwise, and the
adoption became final in 2013 or earlier.
• You adopted a child with special needs and the adoption became final in 2013.
Form 8839 (2013)