Form 2441 Department of the Treasury Internal Revenue Service (99) | Child and Dependent Care Expenses Attach to Form 1040, 1040-SR, or Form 1040-NR. Go to www.irs.gov/Form2441 for instructions and the latest information. | | OMB No. 1545-0074 | 2019 Attachment Sequence No. 21 | Name(s) shown on return Paul and Karen Kent | Your social security number 123-45-6789 | You cannot claim a credit for child and dependent care expenses if your filing status is married filing separately unless you meet the requirements listed in the instructions under "Married Persons Filing Separately." If you meet these requirements, check this box. | Part I | Persons or Organizations Who Provided the CareYou must complete this part. | | (If you have more than two care providers, see the instructions.) | 1 | (a) Care provider's name | (b) Address (number, street, apt. no., city, state, and ZIP code) | (c) Identifying number (SSN or EIN) | (d) Amount paid (see instructions) | Sunnyside Day Care Center | 422 Sycamore Road | | | | | | Ft. Worth, TX 76028 | 11-2345678 | fill in the blank 68b7e3feffd8079_1 | | | | | | | | | | | | | | | Did you receive dependent care benefits? | | No | | | Complete only Part II below. | | | Yes | | | Complete Part III on the back next. | Caution: If the care was provided in your home, you may owe employment taxes. If you do, you can't file Form 1040A. For details, see the instructions for Form 1040 or 1040-SR, line 7a, or Form 1040-NR, line 59a. | 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. | | (a) Qualifying person's name | (b) Qualifying person's social security number | (c) Qualified expenses you incurred and paid in 2019 for the person listed in column (a) | First | Last | | Samuel | Kent | 123-45-6788 | fill in the blank 68b7e3feffd8079_2 | | | Joy | Kent | 123-45-6787 | fill in the blank 68b7e3feffd8079_3 | | 3 | Add the amounts in column (c) of line 2. Don't enter more than $3,000 for one qualifying person or $6,000 for two or more persons. If you completed Part III, enter the amount from line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | | | | | 3 | fill in the blank 68b7e3feffd8079_4 | | 4 | Enter your earned income. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 4 | fill in the blank 68b7e3feffd8079_5 | | 5 | If married filing jointly, enter your spouse's earned income (if you or your spouse was a student or was disabled, see the instructions); all others, enter the amount from line 4 | 5 | fill in the blank 68b7e3feffd8079_6 | | 6 | Enter the smallest of line 3, 4, or 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | 6 | fill in the blank 68b7e3feffd8079_7 | | 7 | Enter the amount from Form 1040 or 1040-SR, line 8b; or Form 1040-NR, line 35 . . . . . . . . . . . . . . . . . . . | | | | | | | 7 | fill in the blank 68b7e3feffd8079_8 | | | | | 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: | Over | But not over | | Decimal amount is | | | Over | But not over | | Decimal amount is | $015,000 | | .35 | | | $29,00031,000 | | .27 | 15,00017,000 | .34 | 31,00033,000 | .26 | 17,00019,000 | .33 | 33,00035,000 | .25 | 19,00021,000 | .32 | 35,00037,000 | .24 | 21,00023,000 | .31 | 37,00039,000 | .23 | 23,00025,000 | .30 | 39,00041,000 | .22 | 25,00027,000 | .29 | 41,00043,000 | .21 | 27,00029,000 | .28 | 43,000No limit | .20 | | | | | 8 | X . fill in the blank 68b7e3feffd8079_9 | | | | 9 | Multiply line 6 by the decimal amount on line 8. If you paid 2018 expenses in 2019, see the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | | | | 9 | fill in the blank 68b7e3feffd8079_10 | | 10 | Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions . . . . . . . . . . . . . . . . . . . . . | | | | | | | 10 | fill in the blank 68b7e3feffd8079_11 | | | | | 11 | Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10 here and on Schedule 3 (Form 1040 or 1040-SR), line 2; or Form 1040-NR, line 47 . . . . . . | | | | 11 | fill in the blank 68b7e3feffd8079_12 | | For Paperwork Reduction Act Notice, see your tax return instructions. | Cat. No. 11862M | Form 2441 (2019) | |