Daycare Credit Form 2441
Name
*
First Name
Last Name
Email
*
example@example.com
Parents who have paid for daycare expenses for their children (under age 13)
List of qualifying person and expenses for each
First Name
Last Name
SSN
Total Expenses
1.
2.
3.
4.
5.
Did your employer pay any of these expenses or reimburse you for daycare expenses
Yes
No
You will need to provide us with the SSN of individuals who kept your child or the EIN of the center. MUST HAVE ID# - EXEMPT DOES NOT QUALIFY
Name of Daycare Center or Individual
SSN or EIN
Address
City/State/Zip
Total Amount Paid
Care Provider #1
Care Provider #2
Care Provider #3
Please verify that you are human
*
Submit
Should be Empty: