Fillable Schedule M1cd - Child And Dependent Care Credit

201477

2014

Schedule M1CD, Child and Dependent Care Credit

Sequence #5

The instructions for this schedule are on a separate sheet.

Your First Name and Initial

Last Name

Social Security Number

Children or other qualifying persons for whom you are claiming this credit (see instructions for deﬁ nition of qualifying person):

Name

Birth Date (mmddyyyy)

Social Security Number

Persons or organizations who provided the care:

Social Security Number

Name

Amount paid

(or federal business ID number)

Place an X in this box if you operate a licensed family day care home and are claiming the credit for your own child(ren).

Enter your day care license number:

Place an X in this box if you are a married couple ﬁ ling jointly and are claiming the credit for your child born in 2014

Round amounts to the nearest whole dollar.

All Applicants

1 Federal adjusted gross income (from line 37 of federal Form 1040,

line 21 of Form 1040A, or line 4 of Form 1040EZ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Nontaxable Social Security and/or Railroad Retirement Board beneﬁ ts received

and not included in line 1 above (include amounts deducted for medicare premiums) . . . . . . . . . . . . . . . 2

3 Deduction for payments made to an IRA, SEP or SIMPLE plan (add lines 28 and 32 of Form 1040

or line 17 of Form 1040A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Total payments from programs including MFIP (Minnesota Family Investment Program),

MSA (Minnesota Supplemental Aid), SSI (Supplemental Security Income), GA (General Assistance)

and GRH (Group Residential Housing) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Additional nontaxable income - such as contributions to a 401(k) or deferred compensation

plan and scholarships and grants - that you must include (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . .5

Enter total and type(s) of income

6 Household income. Add lines 1 through 5 (if result is zero or less, enter 0) . . . . . . . . . . . . . . . . . . . . . . . . . 6

If line 6 is more than $39,000, STOP HERE. You are not eligible for the credit.

7 Credit amount (from the table on page 2 of this form) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Amount from line 9 of federal Form 2441 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

9 Amount from line 7 or line 8, whichever is less. Full-year residents, enter the result here

and on line 24 of Form M1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Part-Year Residents, Nonresidents, American Indians Living on a Reservation and Taxpayers with

JOBZ Business Income

10 If you are married

If you are single

. . . . 10

add lines 4 and 5 of federal Form 2441.

enter line 4 of Form 2441

11 Portion of the amount on line 10 that is taxable to Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 Divide Line 11 by line 10. Enter the result as a decimal (carry to ﬁ ve decimal places) . . . . . . . . . . . . . . . 12

13 Multiply line 9 by line 12. Enter the result here and on line 24 of Form M1 . . . . . . . . . . . . . . . . . . . . . 13

Include this schedule and a copy of your federal Form 2441 with your Form M1.

Enter the number of qualifying persons in the box provided on line 24 on Form M1.