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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 <br />  <br />  <br />  <br />  <br />  <br />  <br />  <br />  <br />  <br />  <br />  <br />  <br />  <br />"" <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