Form  
8839
Department of the Treasury  
Internal Revenue Service (99)
Qualified Adoption Expenses
a
 Attach to Form 1040 or 1040NR.
a
.
OMB No. 1545-0074
20
13
Attachment   
Sequence No. 
38
Name(s) shown on return
Your social security number
Part I
Information About Your Eligible Child or Children-
 
details, including what to do if you need more space.
1
(a) 
Child’s name
(b) 
Child’s year 
of birth
Check if child was—
(c) 
born 
before
 
1996 
and
 
disabled
(d) 
a child 
with special  
needs
(e) 
a 
foreign 
child
(f) 
Child’s 
identifying number
(g) 
Check if 
adoption 
became final in 
2013 or earlier 
     
First
Last
                                                                                                                                          
Child 
1
Child 
2
Child 
3
Caution. 
 
Part II
Adoption Credit
Child 1
     
Child 2
     
Child 3
     
2  
 
Maximum adoption credit per 
2 
3  
 
Did you file Form 8839 for a 
prior year for the same child?
No.
Enter -0-.
Yes.
See instructions for 
the amount to enter.
}
3 
4 
Subtract line 3 from line 2     .
4 
5  
 
Qualified adoption expenses 
(see instructions)
....
Caution.
Your qualified
adoption expenses may not be 
equal to the adoption expenses 
you paid in 2013.
5 
6 
Enter the 
smaller 
of line 4 or line 5
6 
7
Enter modified adjusted gross income (see instructions)
......
7
8
Is line 7 more than $194,580?
No.
Skip lines 8 and 9, and enter -0- on line 10.
Yes.
Subtract $194,580 from line 7
...........
8
9 
 
Divide line 8 by $40,000. Enter the result as a decimal (rounded to at least three places).  
Do not enter more than 1.000
......................
9
×
.
                                                                                                                                                                                         
10 
 
Multiply each amount on line 6 
by line 9
.......
10
11
Subtract line 10 from line 6   .
11
12 
Add the amounts on line 11
 
.......................
12
13 
Credit carryforward, if any, from 2012. See the 2012 to 2013 Credit Carryforward Worksheet in
the instructions
 
...........................
13
14 
Add lines 12 and 13
 
.........................
14
15
Enter the amount from line 5 of the Credit Limit Worksheet in the instructions  
......
15
16      Adoption Credit. 
Enter the smaller of line 14 or line 15 here and on Form 1040, line 53, or Form
"8839"
is smaller than line 14, you may have a credit carryforward (see instructions)
 
.......
16
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 22843L
Form 
8839
 (2013) 
You must complete this part. See instructions for 
 For information about Form 8839 and its separate instructions, see www.irs.gov/form8839
If the child was a foreign child, see Special rules in the instructions for line 1, column (e) beforeyou complete Part II or 
Part III. If you received employer-provided adoption benefits, complete Part III on the back next.
child $12,970
 in the space next to box c.. If line 15 
1040NR, line 50. Check box c. on that line and enter 
----------------Page (0) Break----------------
Form 8839 (2013)
Page 
2 
Part III
Employer-Provided Adoption Benefits
                                                                
Child 1
     
Child 2
     
Child 3
     
17
Maximum exclusion per child 
17
18
Did you receive employer-
provided adoption benefits for a 
prior year for the same child?
No.  
Enter -0-.
Yes.
See instructions for 
the amount to enter.
}
18
19
Subtract line 18 from line 17
19
20
Employer-provided adoption 
benefits you received in 2013. 
This amount should be shown 
in box 12 of your 2013 Form(s) 
W-2 with code 
T 
....
20
21
Add the amounts on line 20
.......................
21
                                                                                                        
22
Enter the 
smaller 
of line 19 or 
line 20. But if the child was a 
child with special needs and the 
adoption became final in 2013, 
enter the amount from line 19
22
23
Enter modified adjusted gross income (from 
the worksheet in the instructions)
....
23
24
Is line 23 more than $194,580?
No.  
Skip lines 24 and 25, and enter -0- 
on line 26.
Yes. 
24
25 
 
Divide line 24 by $40,000. Enter the result as a decimal (rounded to 
at least three places). Do not enter more than 1.000
.....
25
×
.
                                                                                                       
26
Multiply each amount on line 22 
by line 25 
.......
26
27      Excluded benefits. 
Subtract 
line 26 from line 22
....
27
28
Add the amounts on line 27 
.......................
28
29      Taxable benefits. 
Is line 28 more than line 21?
No.
Subtract line 28 from line 21. Also, include this amount, if more than zero, on 
line 7 of Form 1040 or line 8 of Form 1040NR. On the dotted line next to line 
7 of Form 1040 or line 8 of Form 1040NR, enter “AB.”
Yes.
Subtract line 21 from line 28. Enter the result as a negative number. Reduce 
the total you would enter on line 7 of Form 1040 or line 8 of Form 1040NR by
the amount on Form 8839, line 29. Enter the result on line 7 of Form 1040  or 
line 8 of Form 1040NR. Enter “SNE” on the dotted line next to the entry line.
}
..
29
TIP
You may be able to claim the adoption credit in Part II on the front of this form if any of the following apply.  
• You paid adoption expenses in 2012, those expenses were not fully reimbursed by your employer or otherwise, and 
the adoption was not final by the end of 2012.  
• The total adoption expenses you paid in 2013 were not fully reimbursed by your employer or otherwise, and the 
adoption became final in 2013 or earlier.  
• You adopted a child with special needs and the adoption became final in 2013.
Form 
8839 
(2013) 
$12,970
Subtract $194,580 from line 23
----------------Page (1) Break----------------