4029 Application for Exemption From Social Security and Medic

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Form

8814

Department of the Treasury
Internal Revenue Service

Name(s) shown on your return

OMB No. 1545-0074

Parents’ Election To Report
Child’s Interest and Dividends

2006

䊳

䊳

See instructions.
Attach to parents’ Form 1040 or Form 1040NR.

Attachment
Sequence No.

40

Your social security number

f
o
s
a
6
t
0
f
0
a
2
r
/
D /26
9
0

Caution. The federal income tax on your child’s income, including qualified dividends and capital gain distributions, may be less
if you file a separate tax return for the child instead of making this election. This is because you cannot take certain tax benefits
that your child could take on his or her own return. For details, see Tax benefits you cannot take on page 2.
A

Child’s name (first, initial, and last)

C

If more than one Form 8814 is attached, check here

Part I

B Child’s social security number

Child’s Interest and Dividends To Report on Your Return

1a Enter your child’s taxable interest. If this amount is different from the amounts shown on the
child’s Forms 1099-INT and 1099-OID, see the instructions
b Enter your child’s tax-exempt interest. Do not include this
1b
amount on line 1a
2a Enter your child’s ordinary dividends, including any Alaska Permanent Fund dividends. If your
child received any ordinary dividends as a nominee, see the instructions
b Enter your child’s qualified dividends included on line 2a. See
2b
instructions
3
4

5
6

7
8
9
10
11
12

Enter your child’s capital gain distributions. If your child received any capital gain distributions
as a nominee, see the instructions

Add lines 1a, 2a, and 3. If the total is $1,700 or less, skip lines 5 through 12 and go to line 13.
If the total is $8,500 or more, do not file this form. Your child must file his or her own return
to report the income
Base amount
Subtract line 5 from line 4
If both lines 2b and 3 are zero or blank, skip lines 7 through 10, enter -0- on line 11, and
go to line 12. Otherwise, go to line 7.
Divide line 2b by line 4. Enter the result as a decimal (rounded
.
7
to at least three places)
Divide line 3 by line 4. Enter the result as a decimal (rounded to
.
8
at least three places)
Multiply line 6 by line 7. Enter the result here. See the instructions
9
for where to report this amount on your return
Multiply line 6 by line 8. Enter the result here. See the instructions
10
for where to report this amount on your return
Add lines 9 and 10
Subtract line 11 from line 6. Include this amount in the total on Form 1040, line 21, or Form
1040NR, line 21. In the space next to line 21, enter “Form 8814” and show the amount. If you
checked the box on line C above, see the instructions. Go to line 13 below

Part II

䊳

1a

2a

3

4
5
6

1,700

00

11

12

Tax on the First $1,700 of Child’s Interest and Dividends

13
850 00
Amount not taxed
14
Subtract line 13 from line 4. If the result is zero or less, enter -0Tax. Is the amount on line 14 less than $850?
15
No. Enter $85 here and see the Note below.
Yes. Multiply line 14 by 10% (.10). Enter the result here and see the Note below.
Note. If you checked the box on line C above, see the instructions. Otherwise, include the amount from line 15 in the tax you enter
on Form 1040, line 44, or Form 1040NR, line 41. Be sure to check box a on Form 1040, line 44, or Form 1040NR, line 41.

13
14
15

For Paperwork Reduction Act Notice, see page 3.

其

Cat. No. 10750J

Form

8814

(2006)