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Form 2441 Child and Dependent Care Expenses 2005. Summary: This is an example of Form 2441 (2005) as pertains to the text. The completed line items are:

Name(s) shown on Form 1040” field contains Joan Thomas
Your social security number” field contains 559-00-3436
Under “Part I: Persons or Organizations Who Provided the Care”:
1(a) Care provider's name” field contains
Pat Green
ACME Computers
1(b) Address (number, street, apartment number, city, state, and ZIP code)” field contains
12 Ash Avenue, Hometown, Texas 75240
(See W-2)
1(c) Identifying number (S.S.N. or E.I.N.)” field contains
240-00-3811
1(d) Amount paid (see instructions)” field contains
2,400
Under “Part II: Credit for Child and Dependent Care Expenses”:
2. Information about your qualifying person(s).
(a) Qualifying person's name: First Last” field contains
Seth Thomas
Susan Thomas
(b) Qualifying person's social security number” field contains
559-00-1234
559-00-5678
(c) Qualified expenses you incurred and paid in 2005 for the person listed in column (a)” field contains
2,400
3. Add the amounts in column (c) of line 2. Do not enter more then $3,000 for one qualifying person or $6,000 for two or more persons. If you completed Part III, enter the amount from line 32” field contains 2,400
4. Enter your earned income” field contains 29,000
5. If married filing jointly, enter your spouse's earned income (if your spouse was a student or was disabled, see the instructions); all others, enter the amount from line 4” field contains 29,000
6. Enter the smallest of line 3, 4, or 5” field contains 2,400
7. Enter the amount from Form 1040, line 38” field contains 29,000
8. Enter on line 8 the decimal amount shown below that applies to the amount on line 7” field contains .28
9. Multiply line 6 by the decimal amount on line 8. If you paid 2004 expenses in 2005, see the instructions” field contains 672
10. Enter the amount from Form 1040, line 46, minus any amount on Form 1040, line 47” field contains 1,296
11. Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10 here and on Form 1040, line 48” field contains 672