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Fillable Printable Form 8839

Fillable Printable Form 8839

Form 8839

Form 8839

Form 8839
Department of the Treasury
Internal Revenue Service (99)
Qualified Adoption Expenses
Attach to Form 1040 or 1040NR.
For information about Form 8839 and its separate instructions, see www.irs.gov/form8839.
OMB No. 1545-0074
2016
Attachment
Sequence No.
38
Name(s) shown on returnYour social security number
Part IInformation About Your Eligible Child or Children—You must complete this part. Seeinstructions for
details, including what to do if you need more space.
1
(a)
Child’s name
(b)
Child’s year
of birth
Check if child was—
(c)
born before
1999 and
disabled
(d)
a child
with special
needs
(e)
a
foreign
child
(f)
Child’s
identifying number
(g)
Check if
adoption
became final in
2016 or earlier
FirstLast
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), beforeyou complete Part II or
Part III. If you received employer-provided adoption benefits, complete Part III on the back next.
Part IIAdoption Credit
Child 1
Child 2
Child 3
2
Maximum adoption credit per
child........
2
3
Did you file Form 8839 for a
prior year for the same child?
No.Enter -0-.
Yes.See instructions for
the amount to enter.
}
3
4 Subtract line 3 from line 2 .4
5
Qualified adoption expenses
(see instructions)....
Caution: Your qualified
adoption expenses may not be
equal to the adoption expenses
you paid in 2016.
5
6
Enter the smaller of line 4 or line 5
6
7
Enter modified adjusted gross income (see instructions)......
7
8Is line 7 more than $201,920?
No.Skip lines 8 and 9, and enter -0- on line 10.
Yes.Subtract $201,920 from line 7...........
8
9
Divideline8 by$40,000. Enterthe resultas adecimal(roundedto atleastthreeplaces).
Do not enter more than 1.000......................
9
×
.
10
Multiply each amount on line 6
by line 9.......
10
11Subtract line 10 from line 6.11
12 Add the amounts on line 11.......................12
13 Credit carryforward, if any, from prior years. See your Adoption Credit Carryforward Worksheet
in the 2015 Form 8839 instructions....................
13
14 Add lines 12 and 13.........................14
15Enter the amount from line 5 of the Credit Limit Worksheet in the instructions ......15
16Adoption Credit. Enter the smaller of line 14 or line 15 here and on Form 1040, line 54, or Form
1040NR, line 51. Check box con 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).......
16
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 22843L
Form 8839 (2016)
$13,460
00
$13,460
00
$13,460
00
Form 8839 (2016)
Page 2
Part III
Employer-Provided Adoption Benefits
Child 1
Child 2
Child 3
17Maximum exclusion per child 17
18
Did you receive employer-
provided adoption benefits for a
prior year for the same child?
No. Enter -0-.
Yes.See instructions for
the amount to enter.
}
18
19Subtract line 18 from line 17
19
20Employer-provided adoption
benefits you received in 2016.
This amount should be shown
in box 12 of your 2016 Form(s)
W-2 with code T ....
20
21Add the amounts on line 20.......................
21
22Enter the smaller of line 19 or
line 20. But if the child was a
child with special needs and the
adoption became final in 2016,
enter the amount from line 19
22
23Enter modified adjusted gross income (from
the worksheet in the instructions)....
23
24Is line 23 more than $201,920?
No. Skip lines 24 and 25, and enter -0-
on line 26.
Yes.
Subtract $201,920 from line
23
24
25
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.....
25
×
.
26Multiply each amount on line 22
by line 25 .......
26
27Excluded benefits. Subtract
line 26 from line 22....
27
28Add the amounts on line 27 .......................
28
29Taxable 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.
}
..29
TIP
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 2015, those expenses were not fully reimbursed by your employer or otherwise, and
the adoption was not final by the end of 2015.
The total adoption expenses you paid in 2016 were not fully reimbursed by your employer or otherwise, and the
adoption became final in 2016 or earlier.
• You adopted a child with special needs and the adoption became final in 2016.
Form 8839 (2016)
$13,460
00
$13,460
00
$13,460
00
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