Jasper2(6-41) - 2441 Form OMB No. 1545-0074 Child and...

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OMB No. 1545-0074 Child and Dependent Care Expenses 2441 Form ' Attach to Form 1040 or Form 1040NR. Department of the Treasury Internal Revenue Service Attachment Sequence No. 21 ' See separate instructions. Name(s) shown on return Your social security number Persons or Organizations Who Provided the Care— You must complete this part. (If you have more than two care providers, see the instructions.) (b) Address (number, street, apt. no., city, state, and ZIP code) (d) Amount paid (see instructions) (c) Identifying number (SSN or EIN) 1 (a) Care provider’s name Credit for Child and Dependent Care Expenses 2 Add the amounts in column (c) of line 2. Do not enter more than $3,000 for one qualifying person or $6,000 for two or more persons. If you completed Part III, enter the amount from line 35 Enter your earned income. See instructions 3 3 If married filing jointly, enter your spouse’s earned income (if your spouse was a student or was disabled, see the instructions); all others, enter the amount from line 4 4 4 Enter the smallest of line 3, 4, or 5 5 5 6 7 Enter the amount from Form 1040, line 38, or Form 1040NR, line 36 7 3 Decimal amount is If line 7 is: Decimal amount is If line 7 is: But not over Over But not over Over .27 $29,000—31,000 .35 $0—15,000 .26 31,000—33,000 .34 15,000—17,000 .25 33,000—35,000 .33 17,000—19,000 .24 35,000—37,000 .32
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Jasper2(6-41) - 2441 Form OMB No. 1545-0074 Child and...

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