—YOU MUST INCLUDE THIS SCHEDULE WITH YOUR OREGON TAX RETURN TO RECEIVE THIS CREDIT —
Household Size Calculation
 
 
1.
 
Enter the number of exemptions   
you claimed on your federal return
 
............................
1
 
2.
 
Enter the number of exemptions you did not 
     
     
 
..................
2
 
3.
 
Add lines 1 and 2
 
.......................................................
3
 
 
4.
 
Enter the number of exemptions you claimed on your
     
     
household during 2013, including exemptions released
     
     
 
............
4
 
5.
 
Household size. Line 3 minus line 4
 
...........................
5
Schedule  
WFC 
2013
Oregon Working Family Child Care Credit
for Full-Year Residents
$
  9.
 
 
9
$
$
$
$
 
First and Last Name of Child
Child’s SSN
Child’s
Date of Birth
Relationship 
 
10.
 
11.
 
12.
 
13.
Qualifying Expenses 
You Paid for Child
Last name
Spouse’s/RDP’s last name if joint return
First name and initial
Spouse’s/RDP’s first name and initial if joint return
Social Security number (SSN)
Spouse’s/RDP’s SSN if joint return
Attending school
Attending school
Form WFC-DP is included
Form WFC-DP is included
Provider’s full name and complete address 
Amount You Paid to Provider
$
Child to Provider 
 
Provider’s SSN or
 
6.
 
Name
 
__________________________________________________________________________________________
       
Addr
ess
 
_______________________________________________________________________________________
  
City, State, ZIP Code
Provider’s Telephone No.
.............. 6
$
 
14.
 
 
.................
14
Computation of Credit
 
15.
 
Enter your federal adjusted gross income (Form 40, line 8)
 
................................................................................................
15
 
16.
 
 
............................................................
16 
 
17.
 
      
matches your household size on line 5 above). For example, if the amount on line 5 is 4, use Table 4
 
............................
17
 
18.
 
      
 
......................................................................................................................
18
x 
 
 
 
Provider’s full name and complete address 
Amount You Paid to Provider
$
 
7.
 
Name
 
__________________________________________________________________________________________
       
Addr
ess
 
_______________________________________________________________________________________
  
City, State, ZIP Code
Provider’s Telephone No.
.............. 7
PA
YMENT OF YOUR CHILD CARE EXPENSES
Child to Provider 
 
Provider’s full name and complete address 
Amount You Paid to Provider
$
 
8.
 
Name
 
__________________________________________________________________________________________
       
Addr
ess
 
_______________________________________________________________________________________
  
City, State, ZIP Code
Provider’s Telephone No.
.............. 8
Child to Provider 
 
150-101-169 (Rev. 12-13)
   -  -
   -  -
FOR COMPUTER USE ONLY
YOU MAY BE REQUIRED TO PROvIDE PROOF OF YOUR 
claim on your federal return because you released 
the exemption to the child’s other parent
federal return for people who did not live in your
to you by your child’s other parent, or who are not
related by blood, marriage, RDP, or adoption
Qualifying Child Care Expenses Paid in 2013. Complete all information for each child care provider you paid in 2013.
Enter the total qualifying child care expenses you paid in 2013 from line 9 above
Enter the decimal amount from the working family child care credit table on the back (use the table that 
Multiply the amount on line 16 by the decimal amount on line 17. Enter the result here and on Form 40, line 45.
This is your working family child care credit 
Add amounts on lines 6 through 8 and enter the result here.
 
If you have more than three providers, enter additional qualifying providers
 
and check here   9a 
Add amounts on lines 10 through 13 and enter the result here.
 
If you have more than four qualifying children, enter additional qualifying children
and check here   14a
.................
Provider’s FEIN
Provider’s SSN or
Provider’s FEIN
Provider’s SSN or
Provider’s FEIN
Relationship
Relationship
Relationship
Qualifying Child Information--Complete all information
 
for each child
Child to Taxpayer 
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