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—YOU MUST INCLUDE THIS SCHEDULE WITH YOUR OREGON TAX RETURN TO RECEIVE THIS CREDIT — Household Size Calculation 1. Enter the number of exemptions you claimed on your federal return ............................ 1 2. Enter the number of exemptions you did not .................. 2 3. Add lines 1 and 2 ....................................................... 3 4. Enter the number of exemptions you claimed on your household during 2013, including exemptions released ............ 4 5. Household size. Line 3 minus line 4 ........................... 5 Schedule WFC 2013 Oregon Working Family Child Care Credit for Full-Year Residents $ 9. 9 $ $ $ $ First and Last Name of Child Child’s SSN Child’s Date of Birth Relationship 10. 11. 12. 13. Qualifying Expenses You Paid for Child Last name Spouse’s/RDP’s last name if joint return First name and initial Spouse’s/RDP’s first name and initial if joint return Social Security number (SSN) Spouse’s/RDP’s SSN if joint return Attending school Attending school Form WFC-DP is included Form WFC-DP is included Provider’s full name and complete address Amount You Paid to Provider $ Child to Provider Provider’s SSN or 6. Name __________________________________________________________________________________________ Addr ess _______________________________________________________________________________________ City, State, ZIP Code Provider’s Telephone No. .............. 6 $ 14. ................. 14 Computation of Credit 15. Enter your federal adjusted gross income (Form 40, line 8) ................................................................................................ 15 16. ............................................................ 16 17. matches your household size on line 5 above). For example, if the amount on line 5 is 4, use Table 4 ............................ 17 18. ...................................................................................................................... 18 x Provider’s full name and complete address Amount You Paid to Provider $ 7. Name __________________________________________________________________________________________ Addr ess _______________________________________________________________________________________ City, State, ZIP Code Provider’s Telephone No. .............. 7 PA YMENT OF YOUR CHILD CARE EXPENSES Child to Provider Provider’s full name and complete address Amount You Paid to Provider $ 8. Name __________________________________________________________________________________________ Addr ess _______________________________________________________________________________________ City, State, ZIP Code Provider’s Telephone No. .............. 8 Child to Provider 150-101-169 (Rev. 12-13) - - - - FOR COMPUTER USE ONLY YOU MAY BE REQUIRED TO PROvIDE PROOF OF YOUR claim on your federal return because you released the exemption to the child’s other parent federal return for people who did not live in your to you by your child’s other parent, or who are not related by blood, marriage, RDP, or adoption Qualifying Child Care Expenses Paid in 2013. Complete all information for each child care provider you paid in 2013. Enter the total qualifying child care expenses you paid in 2013 from line 9 above Enter the decimal amount from the working family child care credit table on the back (use the table that Multiply the amount on line 16 by the decimal amount on line 17. Enter the result here and on Form 40, line 45. This is your working family child care credit Add amounts on lines 6 through 8 and enter the result here. If you have more than three providers, enter additional qualifying providers and check here 9a Add amounts on lines 10 through 13 and enter the result here. If you have more than four qualifying children, enter additional qualifying children and check here 14a ................. Provider’s FEIN Provider’s SSN or Provider’s FEIN Provider’s SSN or Provider’s FEIN Relationship Relationship Relationship Qualifying Child Information--Complete all information for each child Child to Taxpayer ----------------Page (0) Break----------------