Fillable Printable Form 8839
Fillable Printable 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 return Your social security number
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.
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
First Last
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
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
8 Is 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
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 . . . . . . . . . . . . . . . . . . . . . .
9
×
.
10
Multiply each amount on line 6
by line 9 . . . . . . .
10
11 Subtract 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
15 Enter the amount from line 5 of the Credit Limit Worksheet in the instructions . . . . . . 15
16 Adoption Credit. Enter the smaller of line 14 or line 15 here and on Form 1040, line 54, or Form
1040NR, line 51. 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) . . . . . . .
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
17 Maximum 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
19 Subtract line 18 from line 17
19
20 Employer-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
21 Add the amounts on line 20 . . . . . . . . . . . . . . . . . . . . . . .
21
22 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 2016,
enter the amount from line 19
22
23 Enter modified adjusted gross income (from
the worksheet in the instructions) . . . .
23
24 Is 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
×
.
26 Multiply each amount on line 22
by line 25 . . . . . . .
26
27 Excluded benefits. Subtract
line 26 from line 22 . . . .
27
28 Add the amounts on line 27 . . . . . . . . . . . . . . . . . . . . . . .
28
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.
}
. . 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
