Form 150-101-170 - Schedule Wfc-N/p - Oregon Working Family Child Care Credit For Form 40n And Form 40p Filers - 2012

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Clear Form
Schedule
2012
Oregon Working Family Child Care Credit
WFC-N/P
for Form 40N and Form 40P Filers
Last name
First name and initial
Social Security number (SSN)
Attending school
-
-
Form WFC-DP is included
Spouse’s/RDP’s last name if joint return
Spouse’s/RDP’s first name and initial if joint return
Spouse’s/RDP’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
1.
you claimed on your federal return ............................ 1
2. Enter the number of exemptions you did not
claim on your federal return because you released
FOR COMPUTER USE ONLY
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
federal return for people who did not live in your
household during 2012, including exemptions released
to you by your child’s other parent, or who are not
related by blood, marriage, RDP, or adoption ............ 4
5. Household size. Line 3 minus line 4 ........................... 5
Qualifying Child Care Expenses Paid in 2012. Complete all information for each child care provider you paid in 2012.
Child to Provider
Provider’s full name and complete address
Relationship
Provider’s SSN or FEIN
(enter code)
6.
Name __________________________________________________________________________________________
Provider’s Telephone No.
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 Telephone No.
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 Telephone No.
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 9a
.........9
Child to
Qualifying Child Information—Complete all information for each child
Taxpayer
Child’s
Qualifying Expenses
Relationship
(enter code)
First and Last Name of Child
Child’s SSN
Date of Birth
You Paid for Child
10.
$
11.
$
$
12.
13.
$
$
14. Add amounts on lines 10 through 13 and enter the result here.
.................14
If you have more than four qualifying children, check here 14a
Computation of Credit
15. Enter your federal adjusted gross income (Form 40N or Form 40P, line 30F) ..................................................................... 15
16. Enter your Oregon adjusted gross income (Form 40N or Form 40P, line 30S) ................................................................... 16
17. Enter the larger of line 15 or line 16 .................................................................................................................................... 17
18. Enter the total qualifying child care expenses you paid in 2012 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 39). Enter the result
here and on Form 40N or Form 40P, line 63. This is your working family child care credit ................................................ 21
—YOU MUST INCLUDE THIS SCHEDULE WITH YOUR OREGON TAX RETURN TO RECEIvE THIS CREDIT —
150-101-170 (Rev. 12-12)

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