Forth 2441 Department of the Treasury internal Revenue Senice (991 Name(s) sho'm on return Child and Dependent Care Expenses lo Attach to Form 1040, Form 1040A, or Form 1040NR. ► Go to www.irs.gov/Form2441 for Instructions and the latest Information. 1040 1040A 1040NR Part I OMB No. 1545-0074 2017 Attachment Sequence No. 21 Your social security number Persons or Organizations Who Provided the Care-You must complete this part. (If you have more than two care providers, see the instructions.) 1 (a) Care providers name (b) Address (number. street. apt. no.. city. state, and ZIP code) (a) Identifying number (SSN cr EIN) (d) Amount pad (see instructions) Did you receive No --10. Complete only Part II below. dependent care benefits? Yes -OP. 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. line 60a. or Form 1040NR. 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 First (b) Qualifying person's social security number (o) Ouallfled expenses you inctrred and paid in 2017 for the person fisted in column (a) 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 o more persons. If you completed Part Ill, enter the amount from line 31 3 4 Enter your earned income. See instructions 4 5 It 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 6 Enter the smallest of line 3, 4, or 5 7 Enter the amount from Form 1040, line 38: Form 1040A, line 22; or Form 1040NR. line 37 I l 8 Enter on line 8 the decimal amount shown below t