Publication 503 - Child And Dependent Care Expenses - 2002 Page 17
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222441
OMB No. 1545-0068
Child and Dependent Care Expenses
Form
2002
Attach to Form 1040.
Attachment
Department of the Treasury
21
See separate instructions.
(99)
Sequence No.
Internal Revenue Service
Name(s) shown on Form 1040
Your social security number
Joan Thomas
559
00
3436
Before you begin: You need to understand the following terms. See Definitions on page 1 of the instructions.
● Qualifying Person(s)
● Qualified Expenses
● Dependent Care Benefits
● Earned Income
Persons or Organizations Who Provided the Care—You must complete this part.
Part I
(If you need more space, use the bottom of page 2.)
(a) Care provider’s
(b) Address
(c) Identifying number
(d) Amount paid
1
name
(number, street, apt. no., city, state, and ZIP code)
(SSN or EIN)
(see instructions)
12 Ash Avenue
Pat Green
Hometown, TX 75240
240-00-3811
2,400
(See W-2)
ACME Computers
No
Complete only Part II below.
Did you receive
dependent care benefits?
Yes
Complete Part III on the back next.
Caution. If the care was provided in your home, you may owe employment taxes. See the instructions for Form 1040, line 60.
Part II
Credit for Child and Dependent Care Expenses
2
Information about your qualifying person(s). If you have more than two qualifying persons, see the instructions.
(c) Qualified expenses you
(a) Qualifying person’s name
(b) Qualifying person’s social
incurred and paid in 2002 for the
security number
First
Last
person listed in column (a)
Seth
Thomas
559 00 1234
2,400
Susan
Thomas
559 00 5678
3
Add the amounts in column (c) of line 2. Do not enter more than $2,400 for one qualifying
person or $4,800 for two or more persons. If you completed Part III, enter the amount
1,800
3
from line 26
29,000
4
4
Enter your earned income
5
If married filing jointly, enter your spouse’s earned income (if your spouse was a student or was
29,000
5
disabled, see the instructions); all others, enter the amount from line 4
1,800
6
Enter the smallest of line 3, 4, or 5
6
29,000
7
7
Enter the amount from Form 1040, line 36
8
Enter on line 8 the decimal amount shown below that applies to the amount on line 7
If line 7 is:
If line 7 is:
But not
Decimal
But not
Decimal
Over
over
amount is
Over
over
amount is
$0—10,000
.30
$20,000—22,000
.24
10,000—12,000
.29
22,000—24,000
.23
.
12,000—14,000
.28
24,000—26,000
.22
8
20
14,000—16,000
.27
26,000—28,000
.21
16,000—18,000
.26
28,000—No limit
.20
18,000—20,000
.25
9
Multiply line 6 by the decimal amount on line 8. If you paid 2001 expenses in 2002, see
9
360
the instructions
1,469
10
10
Enter the amount from Form 1040, line 44, minus any amount on Form 1040, line 45
11
Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10
360
here and on Form 1040, line 46
11
2441
For Paperwork Reduction Act Notice, see page 3 of the instructions.
Cat. No. 11862M
Form
(2002)
Page 17
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