Form 150-101-170 - Schedule Wfc-N/p - Oregon Working Family Child Care Credit For Part-Year Residents And Nonresidents - 2015

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Clear Form
2015
Oregon Working Family Child Care Credit
01541501010000
Schedule WFC-N/P
for Part-year Residents and Nonresidents
First name and initial
Last name
Social Security number (SSN)
Attending school
Form WFC-DP is included
Spouse’s first name and initial
Spouse’s last name
Spouse’s SSN if joint return
Attending school
Form WFC-DP is included
You may be required to provide proof of your payment of
your child care expenses
Household size calculation
Enter the number of exemptions you claimed on
1.
your 2015 federal return ............................................. 1
2. Enter the number of exemptions you didn’t claim on
your 2015 federal return because you released
the exemption to the child’s other parent .................. 2
3. Add lines 1 and 2 ....................................................... 3
4. Enter the number of exemptions you claimed on
your 2015 federal return for people who didn’t live
in your household during 2015, including exemptions
released to you by your child’s other parent, or who
aren’t related by blood, marriage, or adoption ........... 4
5. Household size. Line 3 minus line 4 ........................... 5
Qualifying child care expenses paid in 2015. Complete all information for each child care provider you paid in 2015.
Provider’s full name and complete address
Provider’s SSN or FEIN
Child to provider relationship
(enter code)
6.
Name __________________________________________________________________________________________
Provider’s phone number
Amount you paid to provider
Address _______________________________________________________________________________________
$
.............. 6
City, State, ZIP code
Child to provider
Provider’s full name and complete address
relationship
Provider’s SSN or FEIN
(enter code)
7.
Name __________________________________________________________________________________________
Provider’s phone number
Amount you paid to provider
Address _______________________________________________________________________________________
$
.............. 7
City, State, ZIP code
Child to provider
Provider’s full name and complete address
relationship
Provider’s SSN or FEIN
(enter code)
8.
Name __________________________________________________________________________________________
Provider’s phone number
Amount you paid to provider
Address _______________________________________________________________________________________
$
...............8
City, State, ZIP code
9. Add amounts on lines 6 through 8 and enter the result here.
$
If you have more than three providers, check here and include a statement 9a
..................................................................9
Child to
Qualifying child information—Complete all information for each child
Child’s
Qualifying expenses
taxpayer
date of birth
you paid for
relationship
First and last name of child
(enter code)
Child’s SSN
(mm/dd/yyyy)
child care
$
10.
11.
$
12.
$
$
13.
14. Add amounts on lines 10 through 13 and enter the result here.
If you have more than four qualifying children, check here and include a statement
$
14a
........................................ 14
Computation of credit
15. Enter your federal adjusted gross income (Form 40N or Form 40P, line 29F) ..................................................................... 15
16. Enter your Oregon adjusted gross income (Form 40N or Form 40P, line 29S) ................................................................... 16
17. Enter the larger of line 15 or line 16 .................................................................................................................................... 17
18. Enter the total qualifying child care expenses you paid in 2015 from line 9 above ............................................................ 18
19. Enter the decimal amount from the working family child care credit table on the back (use the table that
.
x
matches your household size on line 5 above). For example, if the amount on line 5 is 4, use Table 4 ......................................... 19
20. Multiply the amount on line 18 by the decimal amount on line 19 and enter here ............................................................. 20
21. Multiply line 20 by the Oregon percentage (Form 40N or Form 40P, line 35). Enter the result
here and on Schedule OR-ASC-N/P, Section 7, using code 893. This is your working family child care credit ................ 21
—You must include this schedule and a copy of your federal return with your Oregon tax return to receive this credit—
150-101-170 (Rev. 12-15)

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