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Form 8839 Department of the Treasury Internal Revenue Service (99) Qualified Adoption Expenses a Attach to Form 1040 or 1040NR. a . OMB No. 1545-0074 20 13 Attachment Sequence No. 38 Name(s) shown on return Your social security number Part I Information About Your Eligible Child or Children- details, including what to do if you need more space. 1 (a) Child’s name (b) Child’s year of birth Check if child was— (c) born before 1996 and disabled (d) a child with special needs (e) a foreign child (f) Child’s identifying number (g) Check if adoption became final in 2013 or earlier First Last Child 1 Child 2 Child 3 Caution. Part II Adoption Credit Child 1 Child 2 Child 3 2 Maximum adoption credit per 2 3 Did you file Form 8839 for a prior year for the same child? No. Enter -0-. Yes. See instructions for the amount to enter. } 3 4 Subtract line 3 from line 2 . 4 5 Qualified adoption expenses (see instructions) .... Caution. Your qualified adoption expenses may not be equal to the adoption expenses you paid in 2013. 5 6 Enter the smaller of line 4 or line 5 6 7 Enter modified adjusted gross income (see instructions) ...... 7 8 Is line 7 more than $194,580? No. Skip lines 8 and 9, and enter -0- on line 10. Yes. Subtract $194,580 from line 7 ........... 8 9 Divide line 8 by $40,000. Enter the result as a decimal (rounded to at least three places). Do not enter more than 1.000 ...................... 9 × . 10 Multiply each amount on line 6 by line 9 ....... 10 11 Subtract line 10 from line 6 . 11 12 Add the amounts on line 11 ....................... 12 13 Credit carryforward, if any, from 2012. See the 2012 to 2013 Credit Carryforward Worksheet in the instructions ........................... 13 14 Add lines 12 and 13 ......................... 14 15 Enter the amount from line 5 of the Credit Limit Worksheet in the instructions ...... 15 16 Adoption Credit. Enter the smaller of line 14 or line 15 here and on Form 1040, line 53, or Form "8839" is smaller than line 14, you may have a credit carryforward (see instructions) ....... 16 For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 22843L Form 8839 (2013) You must complete this part. See instructions for For information about Form 8839 and its separate instructions, see www.irs.gov/form8839 If the child was a foreign child, see Special rules in the instructions for line 1, column (e) beforeyou complete Part II or Part III. If you received employer-provided adoption benefits, complete Part III on the back next. child $12,970 in the space next to box c.. If line 15 1040NR, line 50. Check box c. on that line and enter ----------------Page (0) Break---------------- Form 8839 (2013) Page 2 Part III Employer-Provided Adoption Benefits Child 1 Child 2 Child 3 17 Maximum exclusion per child 17 18 Did you receive employer- provided adoption benefits for a prior year for the same child? No. Enter -0-. Yes. See instructions for the amount to enter. } 18 19 Subtract line 18 from line 17 19 20 Employer-provided adoption benefits you received in 2013. This amount should be shown in box 12 of your 2013 Form(s) W-2 with code T .... 20 21 Add the amounts on line 20 ....................... 21 22 Enter the smaller of line 19 or line 20. But if the child was a child with special needs and the adoption became final in 2013, enter the amount from line 19 22 23 Enter modified adjusted gross income (from the worksheet in the instructions) .... 23 24 Is line 23 more than $194,580? No. Skip lines 24 and 25, and enter -0- on line 26. Yes. 24 25 Divide line 24 by $40,000. Enter the result as a decimal (rounded to at least three places). Do not enter more than 1.000 ..... 25 × . 26 Multiply each amount on line 22 by line 25 ....... 26 27 Excluded benefits. Subtract line 26 from line 22 .... 27 28 Add the amounts on line 27 ....................... 28 29 Taxable benefits. Is line 28 more than line 21? No. Subtract line 28 from line 21. Also, include this amount, if more than zero, on line 7 of Form 1040 or line 8 of Form 1040NR. On the dotted line next to line 7 of Form 1040 or line 8 of Form 1040NR, enter “AB.” Yes. Subtract line 21 from line 28. Enter the result as a negative number. Reduce the total you would enter on line 7 of Form 1040 or line 8 of Form 1040NR by the amount on Form 8839, line 29. Enter the result on line 7 of Form 1040 or line 8 of Form 1040NR. Enter “SNE” on the dotted line next to the entry line. } .. 29 TIP You may be able to claim the adoption credit in Part II on the front of this form if any of the following apply. • You paid adoption expenses in 2012, those expenses were not fully reimbursed by your employer or otherwise, and the adoption was not final by the end of 2012. • The total adoption expenses you paid in 2013 were not fully reimbursed by your employer or otherwise, and the adoption became final in 2013 or earlier. • You adopted a child with special needs and the adoption became final in 2013. Form 8839 (2013) $12,970 Subtract $194,580 from line 23 ----------------Page (1) Break----------------