00000000: 00 06 20 20 20 20 20 20 20 20 20 20 20 20 20 20 |.. |
00000010: 20 20 20 20 20 20 20 20 20 20 20 20 20 20 0D 0A | ..|
00000020: 70 41 52 54 20 31 20 63 72 65 64 69 74 20 66 6F |pART 1 credit fo|
00000030: 72 20 63 68 69 6C 64 20 26 20 64 65 70 2E 20 63 |r child & dep. c|
00000040: 61 72 65 20 20 20 0D 0A 0D 0A 20 31 20 20 6E 4F |are .... 1 nO|
00000050: 2E 20 4F 46 20 51 55 41 4C 49 46 59 49 4E 47 20 |. OF QUALIFYING |
00000060: 50 45 52 53 4F 4E 53 0D 0A 20 20 20 20 61 4D 4F |PERSONS.. aMO|
00000070: 55 4E 54 20 4F 46 20 45 58 50 2E 20 49 4E 43 55 |UNT OF EXP. INCU|
00000080: 52 52 45 44 20 41 4E 44 0D 0A 20 20 20 20 41 43 |RRED AND.. AC|
00000090: 54 55 41 4C 4C 59 20 50 41 49 44 0D 0A 20 20 20 |TUALLY PAID.. |
000000A0: 20 4D 41 58 49 4D 55 4D 20 45 4C 49 47 49 42 4C | MAXIMUM ELIGIBL|
000000B0: 45 20 45 58 50 45 4E 53 45 53 0D 0A 20 32 20 20 |E EXPENSES.. 2 |
000000C0: 61 4D 4F 55 4E 54 20 4F 46 20 51 55 41 4C 49 46 |aMOUNT OF QUALIF|
000000D0: 59 49 4E 47 20 45 58 50 2E 0D 0A 20 33 20 20 65 |YING EXP... 3 e|
000000E0: 41 52 4E 45 44 20 49 4E 43 4F 4D 45 0D 0A 20 20 |ARNED INCOME.. |
000000F0: 41 20 79 4F 55 52 20 65 41 52 4E 45 44 20 49 4E |A yOUR eARNED IN|
00000100: 43 4F 4D 45 0D 0A 20 69 46 20 59 4F 55 52 20 53 |COME.. iF YOUR S|
00000110: 50 4F 55 53 45 20 49 53 20 44 49 53 41 42 4C 45 |POUSE IS DISABLE|
00000120: 44 20 0D 0A 20 4F 52 20 41 20 46 55 4C 4C 2D 54 |D .. OR A FULL-T|
00000130: 49 4D 45 20 53 54 55 44 45 4E 54 20 53 45 45 20 |IME STUDENT SEE |
00000140: 0D 0A 20 49 4E 53 54 52 55 43 54 49 4F 4E 53 20 |.. INSTRUCTIONS |
00000150: 54 4F 20 44 45 54 45 52 4D 49 4E 45 20 33 42 0D |TO DETERMINE 3B.|
00000160: 0A 20 20 42 20 79 4F 55 52 20 53 50 4F 55 53 45 |. B yOUR SPOUSE|
00000170: 0D 0A 20 20 43 20 73 4D 41 4C 4C 45 52 20 4F 46 |.. C sMALLER OF|
00000180: 20 33 41 20 6F 72 20 33 42 0D 0A 20 34 20 20 73 | 3A or 3B.. 4 s|
00000190: 4D 41 4C 4C 45 52 20 4C 49 4E 45 20 32 20 26 20 |MALLER LINE 2 & |
000001A0: 33 41 20 6F 72 20 33 43 0D 0A 20 35 20 20 25 20 |3A or 3C.. 5 % |
000001B0: 4F 4E 20 41 4D 54 2D 2D 31 30 34 30 61 20 4C 49 |ON AMT--1040a LI|
000001C0: 4E 45 20 31 33 0D 0A 20 36 20 20 63 48 49 4C 44 |NE 13.. 6 cHILD|
000001D0: 20 26 20 44 45 50 2E 20 43 41 52 45 20 43 52 45 | & DEP. CARE CRE|
000001E0: 44 49 54 0D 0A 0D 0A 70 41 52 54 20 32 20 69 6E |DIT....pART 2 in|
000001F0: 74 65 72 65 73 74 20 69 6E 63 6F 6D 65 0D 0A 0D |terest income...|
00000200: 0A 20 32 20 20 74 4F 54 2E 20 49 4E 54 45 52 45 |. 2 tOT. INTERE|
00000210: 53 54 20 49 4E 43 4F 4D 45 20 28 66 35 29 0D 0A |ST INCOME (f5)..|
00000220: 0D 0A 70 41 52 54 20 33 20 64 69 76 69 64 65 6E |..pART 3 dividen|
00000230: 64 20 69 6E 63 6F 6D 65 0D 0A 0D 0A 20 32 20 20 |d income.... 2 |
00000240: 74 4F 54 2E 20 44 49 56 49 44 45 4E 44 20 49 4E |tOT. DIVIDEND IN|
00000250: 43 4F 4D 45 20 28 66 35 29 0D 0A 74 4F 54 41 4C |COME (f5)..tOTAL|
00000260: 20 49 4E 54 45 52 45 53 54 20 49 4E 43 4F 4D 45 | INTEREST INCOME|
00000270: 20 0D 0A 6E 41 4D 45 0D 0A 61 4D 4F 55 4E 54 0D | ..nAME..aMOUNT.|
00000280: 0A 74 4F 54 41 4C 20 44 49 56 49 44 45 4E 44 20 |.tOTAL DIVIDEND |
00000290: 49 4E 43 4F 4D 45 0D 0A 6E 41 4D 45 0D 0A 61 4D |INCOME..nAME..aM|
000002A0: 4F 55 4E 54 0D 0A 1A |OUNT... |
.. ..PART 1 C
REDIT FOR CHILD & DEP. CARE .... 1 NO
. OF QUALIFYING PERSONS.. AMOUNT OF E
XP. INCURRED AND.. ACTUALLY PAID..
MAXIMUM ELIGIBLE EXPENSES.. 2 AMOUNT O
F QUALIFYING EXP... 3 EARNED INCOME..
A YOUR EARNED INCOME.. IF YOUR SPOUSE IS
DISABLED .. OR A FULL-TIME STUDENT SEE
.. INSTRUCTIONS TO DETERMINE 3B.. B YOU
R SPOUSE.. C SMALLER OF 3A OR 3B.. 4 S
MALLER LINE 2 & 3A OR 3C.. 5 % ON AMT--
1040A LINE 13.. 6 CHILD & DEP. CARE CRE
DIT....PART 2 INTEREST INCOME.... 2 TOT
. INTEREST INCOME (F5)....PART 3 DIVIDEN
D INCOME.... 2 TOT. DIVIDEND INCOME (F5
)..TOTAL INTEREST INCOME ..NAME..AMOUNT.
.TOTAL DIVIDEND INCOME..NAME..AMOUNT...
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