Form D-2441 - Child And Dependent Care Credit For Part-Year Residents - 2012
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1
2D-2441 Child and Dependent
Government of the
2012
District of Columbia
*122410110000*
Care Credit for Part-Year Residents
Important: First calculate your federal return child and dependent care credit.
Print in CAPITAL letters using black ink. Leave lines blank that do not apply.
Vendor ID# 0000
OFFICIAL USE ONLY
Name as shown on Form D-40
Your social security number
Before you begin –
You must meet the following requirements to use this form:
• You are a part-year resident of DC;
• You are fi ling a part-year DC D-40 return; and
• You were eligible to claim the child and dependent care credit on your federal return.
Qualifying dependents
Complete for all qualifying individuals for whom you claimed expenses on your federal Form 2441.
First name
Last name
M.I.
Social security number
Relationship to you
Date of birth (MMDDYYYY)
Lived in your household from MMDDYY to MMDDYY
First name
Last name
M.I.
Social security number
Relationship to you
Date of birth (MMDDYYYY)
Lived in your household from MMDDYY to MMDDYY
First name
Last name
M.I.
Social security number
Relationship to you
Date of birth (MMDDYYYY)
Lived in your household from MMDDYY to MMDDYY
First name
M.I.
Last name
Social security number
Relationship to you
Date of birth (MMDDYYYY)
Lived in your household from MMDDYY to MMDDYY
If you need to list additional dependents, attach a statement with the same information for them.
M
M
D
D
M
M
D
D
DC credit
Round cents to the nearest dollar.
If the amount is zero, leave the line blank.
Enter dates you were a DC resident in 2012.
From
To
$
.00
1
Total 2012 employment-related dependent care expenses
1
From federal Form 2441, Line 3
or total expenses paid (page 2, Line 6 of this form).
$
.00
2
Employment-related dependent care expenses paid in 2012 while you were a DC resident
2
3
3
Divide Line 2 amount by Line 1 amount. (The result will be a decimal, for example: 0.55)
0.
4
DC full-year dependent care credit
Multiply your allowable federal credit (from federal Form 2441,
$
.00
4
Line 9 x .32
$
.00
5
DC part-year dependent care credit
5
Multiply Line 4 amount by the Line 3 decimal.
Enter the amount on Line 23 of Form D-40.
ATTACH THIS FORM TO YOUR FORM D-40.
2012 D-2441 P1
Child and Dependent Care Credit for Part-Year Residents
Revised 3/2013
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