Fillable Printable 2012 Form 3506 - Child And Dependent Care Expenses Credit
Fillable Printable 2012 Form 3506 - Child And Dependent Care Expenses Credit
2012 Form 3506 - Child And Dependent Care Expenses Credit
For Privacy Notice, get form FTB 1131.
FTB 3506 2012 Side 1
3 Add the amounts in column (e) of line 2. Do not enter more than $3,000 for one qualifying person or $6,000 for two
or more qualifying persons. If you completed Side 2, Part IV, enter the amount from line 33 . . . . . . . . . . . . . . . . . . . . . .3 00
4 Enter YOUR earned income. See instructions..........................................................4 00
Nonresidents: Enter only your earned income from California sources. If you do not have earned income from
California sources, stop, you do not qualify for the credit. Military servicemembers, see instructions.
Part-year residents: Enter the total of (1) your earned income from California sources received while you were a
nonresident and (2) all earned income received while you were a resident. Military servicemembers, see instructions.
5 If married or an RDP filing a joint return, enter YOUR SPOUSE’S/RDP’s earned income. (If your spouse/RDP was a
student or was disabled, see the instructions.) If you are not filing a joint return, enter the amount from line 4........5 00
Nonresidents: Enter only your spouse’s/RDP’s earned income from California sources. If your spouse/RDP does not have
earned income from California sources, stop, you do not qualify for the credit. Military servicemembers, see line 4 instructions.
Part-year residents: Enter the total of (1) your spouse’s/RDP’s earned income from California sources received while he or
she was a nonresident and (2) all earned income your spouse/RDP received while he or she was a resident. Military
servicemembers, see line 4 instructions.
6 Enter the smallest of line 3, line 4, or line 5............................................................6 00
7 Enter the decimal amount shown in the chart of the instructions for line 7 ....................................7 X. ___ ___
8 Multiply line 6 by the decimal amount on line 7.........................................................8 00
9 Enter the decimal amount listed in the chart of the instructions for line 9 .....................................9 X. ___ ___
10 Multiply the amount on line 8 by the decimal amount on line 9.............................................10 00
11 Credit for prior year expenses paid in 2012. See instructions for line 11......................................11 00
12
Add line 10 and line 11. Enter the amount here and on Form 540/540A, line 40; or Long Form 540NR, line 50
............12 00
Child and Dependent Care Expenses Credit
T AXABLE YEAR
2012
Name(s) as shown on return
7251123
CALIFORNIA FORM
3506
SSN or ITIN
Part II Persons or Organizations Who Provided the Care in California – You must complete this part. See instructions.
1 Enter the following information for each person or organization that provided care in California. Only care provided in California qualifies for the credit.
If you need more space, attach a separate sheet.
Provider Provider
a. Care provider’s name
b. Care provider’s address
(number, street, apt. no., city, state,
and ZIP Code)
c. Care provider’s telephone number ( ) ( )
d. Is provider a person or organization?
▌
Person
Organization
▌
Person
Organization
e. Identification number (SSN, ITIN, or FEIN)
f. Address where care was provided
(number, street, apt. no., city, state, and
ZIP Code) PO Box not acceptable.
▌▌
g. Amount paid for care provided
Part I Unearned Income and Other Funds Received in 2012. See instructions.
SOURCE OF INCOME/FUNDS AMOUNT SOURCE OF INCOME/FUNDS AMOUNT
Attach to your California Form 540, 540A, or Long Form 540NR.
Part III Credit for Child and Dependent Care Expenses
2 Information about your qualifying person(s). See instructions.
Did you receive dependent care benefits? No.Complete Part III below.
Yes.Complete Part IV on Side 2 before you complete Part III.
(a)
Qualifying person’s name
First Last
(b)
Qualifying person’s
social security number (SSN)
(See instructions)
(c)
Qualifying person’s
date of birth
(DOB – mm/dd/yyyy)
or if disabled
(d)
Percentage of
physical custody
(See instructions)
(e)
Qualified expenses you
incurred and paid in 2012 for
the qualifying person’s
care in California
DOB:_____________
Disabled Yes
DOB:_____________
Disabled Yes
DOB:_____________
Disabled Yes
Side 2 FTB 3506 2012
7252123
Part IV Dependent Care Benefits
13 Enter the total amount of dependent care benefits you received for 2012. This amount should be shown in box 10 of
your Form(s) W-2. Do not include amounts that were reported to you as wages in box 1 of Form(s) W-2. If you were
self-employed or a partner, include amounts you received under a dependent care assistance program from your
sole proprietorship or partnership ...................................................................13 00
14 Enter the amount, if any, you carried over from 2011 and used in 2012 during the grace period ...................14 00
15 Enter the amount, if any, you forfeited or carried forward to 2013...........................................15 ( ) 00
16 Combine line 13 through line 15 ....................................................................16 00
17 Enter the total amount of qualified expenses incurred in 2012 for the
care of the qualifying person(s). See instructions...........................17 00
18 Enter the smaller of line 16 or line 17 ....................................18 00
19 Enter YOUR earned income............................................19 00
20 If married or an RDP filing a joint return, enter YOUR SPOUSE’S/RDP’s earned
income (if your spouse/RDP was a student or was disabled, see the instructions
for line 5); if married or an RDP filing a separate return, see the instructions for the
amount to enter; all others, enter the amount from line 19....................20 00
21 Enter the smallest of line 18, line 19, or line 20.............................21 00
22 Enter $5,000 ($2,500 if married or an RDP filing separately and you were required
to enter your spouse’s/RDP’s earned income on line 20)......................22 00
23 Enter the amount from line 13 that you received from your sole proprietorship or partnership. If you did not receive
any amounts, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23 00
24 Subtract line 23 from line 16 ...........................................24 00
25
Deductible benefits. Enter the smallest of line 21, line 22, or line 23. .......................................25 00
26
Excluded benefits. Subtract line 25 from the smaller of line 21 or line 22. If zero or less, enter -0- .................26 00
27
Taxable benefits. Subtract line 26 from line 24. If zero or less, enter -0- .....................................27 00
28 Enter $3,000 ($6,000 if two or more qualifying persons) .................................................28 00
29 Add line 25 and line 26............................................................................29 00
30 Subtract the amount on line 29 from the amount on line 28. If zero or less, stop. You do not qualify for the credit.
Exception – If you paid 2011 expenses in 2012, see instructions for line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30 00
31 Complete Side 1, Part III, line 2. Add the amounts in column (e) and enter the total here.........................31 00
32 Enter the amount from your federal Form 2441, Part III, line 31 ............................................32 00
33 Enter the smaller of line 30, line 31, or line 32. Also, enter this amount on Side 1, Part III, line 3 and
complete line 4 through line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33 00
Worksheet – Credit for 2011 Expenses Paid in 2012
1. Enter your 2011 qualified expenses paid in 2011. If you did not claim the credit for these expenses on your 2011
return, get and complete a 2011 form FTB 3506 for these expenses. You may need to amend your 2011 return
............. 1.____________________
2. Enter your 2011 qualified expenses paid in 2012 ............................................................. 2.____________________
3. Add the amounts on line 1 and line 2 ...................................................................... 3.____________________
4. Enter $3,000 if care was for one qualifying person ($6,000 for two or more) ........................................ 4.____________________
5. Enter any dependent care benefits received for 2011 and excluded from your income
(from your 2011 form FTB 3506, Part IV, line 26)
............................................................. 5.____________________
6. Subtract amount on line 5 from amount on line 4 and enter the result ............................................. 6.____________________
7. Compare your and your spouse’s/RDP’s earned income for 2011 and enter the smaller amount ......................... 7.____________________
8. If filing a joint return, compare the amounts on line 3, line 6, and line 7 and enter the smallest amount. If not filing
a joint return, enter your earned income.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8.____________________
9. Enter the amount from your 2011 form FTB 3506, Side 1, Part III, line 6 ........................................... 9.____________________
10. Subtract amount on line 9 from amount on line 8 and enter the result. If zero or less, stop here. You cannot increase
your credit by any previous year’s expenses
.................................................................10.____________________
11. Enter your 2011 federal adjusted gross income (AGI) (from your 2011 Form 540/540A, line13;
or Long Form 540NR, line 13)
............................................................................11.____________________
12. 2011 federal AGI decimal amount (from 2011 form FTB 3506, instructions for line 7) .................................12.______ . ______ ______
13. Multiply line 10 by line 12 ...............................................................................13.____________________
14. 2011 California AGI decimal amount (from 2011 form FTB 3506, instructions for line 9) ...............................14.______ . ______ ______
15. Multiply line 13 by line 14. Enter the result here and on your 2012 form FTB 3506, Side 1, Part III, line 11 .................15.____________________
