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OMB No. 1545-0074
<br />Department of the Treasury
<br />Internal Revenue Service AttachmentSequence No.
<br />Was the care provider your
<br />household employee in 2024?
<br />For example, this generally
<br />includes nannies but not
<br />daycare centers.
<br />Check here if the qualifying
<br />person was over age 12 and
<br />was disabled. (see instructions)
<br />you
<br />incurred and paid in 2024 for
<br />the person listed in column (a)
<br />413751 12-12-24
<br />Your social security number
<br />(c) (d) Qualified expenses (a) (b)
<br />If line 7 is:If line 7 is:If line 7 is:But notover Decimalamount is But notover Decimalamount is But notover Decimalamount isOverOverOver
<br />Attach to Form 1040, 1040-SR, or 1040-NR.
<br />Go to www.irs.gov/Form2441 for instructions and the
<br />latest information.
<br />A
<br />B
<br /> must
<br />1 (d)(c)(b) (a) (e)
<br />No
<br />dependent care benefits?Yes
<br />Caution:
<br />2 qualifying person(s).
<br />3 Don't
<br />3
<br />4
<br />5
<br />6
<br />4 earned income.
<br />5
<br />6
<br />7
<br />8
<br />all others,
<br /> smallest
<br />7
<br />8 X
<br />9a
<br />b
<br />c
<br />9a
<br />9b
<br />9c
<br />10
<br />11
<br />10
<br />Credit for child and dependent care expenses.smaller
<br />11
<br />For Paperwork Reduction Act Notice, see your tax return instructions. 2441
<br />Married Persons Filing Separately
<br />If You or Your Spouse Was a Student or Disabled
<br />
<br />Qualifying person's name Qualifying person'ssocial security numberFirstLast
<br />$015,00017,00019,00021,00023,000
<br />15,00017,00019,00021,00023,00025,000
<br />$25,00027,00029,00031,00033,00035,000
<br />27,00029,00031,00033,00035,00037,000
<br />$37,00039,00041,00043,000
<br />39,00041,00043,000No limit
<br />Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions
<br />Form
<br />Name(s) shown on return
<br />You can't claim a credit for child and dependent care expenses if your filing status is married filing separately unless you meet the requirements
<br />listed in the instructions under . If you meet these requirements, check this box
<br />If you or your spouse was a student or was disabled during 2024 and you're entering deemed income of $250 or $500 a month on
<br />Form 2441 based on the income rules listed in the instructions under , check this box
<br />You complete this part.
<br />If you have more than three care providers, see the instructions and check this box
<br /> Identifyingnumber(SSN or EIN)
<br />Address(number, street, apt. no., city, state, and ZIP code)Care provider's name Amount paid
<br />Yes
<br />Yes
<br />Yes
<br />No
<br />No
<br />No
<br />Complete only Part II below.
<br />Complete Part III on page 2 next.
<br />Did you receive
<br /> If the care provider is your household employee, you may owe employment taxes. For details, see the Instructions for
<br />Schedule H (Form 1040). If you incurred care expenses in 2024 but didn't pay them until 2025, or if you prepaid in 2024 for care to
<br />be provided in 2025, don't include these expenses in column (d) of line 2 for 2024. See the instructions.
<br />Information about your If you have more than three qualifying persons, see the instructions and check this box
<br />Add the amounts in column (d) of line 2. enter more than $3,000 if you had one qualifying person or
<br />$6,000 if you had two or more persons. If you completed Part III, enter the amount from line 31 ~~~~~~~~~
<br />Enter your See instructions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
<br />If married filing jointly, enter your spouse's earned income (if you or your spouse was a student or was
<br />disabled, see the instructions); enter the amount from line 4 ~~~~~~~~~~~~~~~~~~~~~
<br />Enter the of line 3, 4, or 5 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
<br />Enter the amount from Form 1040, 1040-SR, or 1040-NR, line 11 ~~~~~~~~~
<br />Enter on line 8 the decimal amount shown below that applies to the amount on line 7.
<br />------
<br />.35.34.33.32.31.30
<br />------
<br />.29.28.27.26.25.24
<br />----
<br />.23.22.21.20
<br />Multiply line 6 by the decimal amount on line 8 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
<br />If you paid 2023 expenses in 2024, complete Worksheet A in the instructions. Enter the amount
<br />from line 13 of the worksheet here. Otherwise, enter -0- on line 9b and go to line 9c
<br />Add lines 9a and 9b and enter the result
<br />~~~~~~~~~~~~~~~
<br />~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
<br />~~~
<br /> Enter the of line 9c or line 10 here and
<br />on Schedule 3 (Form 1040), line 2
<br />LHA Form (2024)
<br />21
<br />Part I Persons or Organizations Who Provided the Care -
<br />Part II Credit for Child and Dependent Care Expenses
<br />Child and Dependent Care Expenses2441 2024
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<br />Stmt 2
<br />Ran & Sharon Oz 621 77 9016
<br />6,250.
<br />6,000.
<br />3,000.
<br />3,000.
<br />.20
<br />0.
<br />Russell JCC
<br />Michael-Ann 18900 NE 25th Ave
<br />N Miami, FL 33180 3,600.
<br />600.
<br />82,285.
<br />3,600.388-87-6326OzBen
<br />600.
<br />4,633.
<br />59-2791269
<br />600.
<br />X
<br />15
<br /> 10440220 163039 1I9016RA 2024.02060 OZ, RAN 1I9016R1
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