Hawaii Individual Income Tax Return (Resident Form)

Individual Income Tax Return (Resident Form)
Individual Income Tax Return Resident
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STATE OF HAWAII — DEPARTMENT OF TAXATION

FORM

N-11
(Rev. 2025)

DO NOT WRITE IN THIS AREA

Individual Income Tax Return
RESIDENT
Calendar Year 2025
OR

N11_F 2025A 01 VID01

Fiscal Year
Beginning

AMENDED Return
NOL Carryback
IRS Adjustment
First Time Filer

and
Ending
FOR OFFICE USE ONLY

Do NOT Submit a Photocopy!!

• ATTACH COPY 2 OF FORM W-2 HERE •

Your	First	Name	

M.I.	

THIS
SPACE
RESERVED

Your	Last	Name	

Suffix

u IMPORTANT — Complete this Section u
Spouse’s	First	Name	

M.I.	

Spouse’s	Last	Name	

Suffix

Enter	the	first	four	letters	
of	your	last	name.
Use ALL CAPITAL	letters	
Your	Social
Security	Number

Care	Of	(See Instructions, page 7.)

Deceased	
Present	mailing	or	home	address	(Number	and	street,	including	Rural	Route)

City,	town	or	post	office	

State	

If	Foreign	address,	enter	Province	and/or	State	

• ATTACH CHECK OR MONEY ORDER HERE •

INSTRUCTIONS
- You can save the form's data by using Adobe Reader XI or higher. You must print,
sign and mail the forms to the Hawaii Department of Taxation. Don't forget to attach
all required forms.
- Use the blue Print Form button at the top of this page to print the form. If you are not
claiming any credits on Schedule CR or Schedule X, you do not need to print them.
- This form uses a 2D barcode on the first page of the form to gather all the forms
data. If you print the form and need to make changes, then type in the changes and
re-print the entire form. Do not make changes to the return data using a pen or pencil.
- Click on the red Reset button at the top of this page to clear all of the form data and
start over.
- Use the Tab key to move forward between fields, Shift+Tab to move backwards
between fields, or use your mouse pointer to click on the field you want.
- To mark a checkbox either click on it using your mouse pointer, or press the space
key.

1
2
3

Date	of	Death

Enter	the	first	four	letters	
of	your	Spouse’s	last	name.	
Use ALL CAPITAL	letters

Postal/ZIP	code

Spouse's	Social
Security	Number

Country

Deceased	

(Place an X in only ONE box)
Single
Married	filing	joint	return	(even	if	only	one	had	income).
Married	filing	separate	return.		Enter	spouse’s	SSN	and	
the	first	four	letters	of	last	name	above.	Enter	spouse’s	full	
name	here.		_____________________________________

4

Head	of	household	(with	qualifying	person).		If	the	qualifying	
person	is	a	child	but	not	your	dependent,	enter	the	child’s	full	
name.

5

Date	of	Death

†

__________________________________
Qualifying	surviving	spouse	(see	page	8	of	the	Instructions)

CAUTION: If you can be claimed as a dependent on another person’s tax return (such as your parents’), DO NOT place an X on line 6a, but be sure to place an X above line 21.
6a
6b

				Yourself .............................................
				Spouse .............................................

				Age	65	or	over ........................................................
				Age	65	or	over ........................................................

}

Enter the number of Xs
on 6a and 6b .................

Â

If	you	placed	an	X	on	lines	3	and	6b	above,	see	the	Instructions	on	page	9	and	if	your	spouse	meets	the	qualifications,	place	an	X	here
6c
and
6d

Dependents:	
1. First	and	last	name	

6e	

N111N4X7

If	more	than	6	dependents	
use	attachment	

2.	Dependent’s	social
security	number	

3. Relationship

Enter	number	of
your	children	listed... 6c

Â

Enter	number	of
other	dependents..... 6d

Â

Total	number	of	exemptions	claimed.		Add	numbers	entered	in	boxes	6a thru 6d	above ..............................................6e

Â

ID NO 01

FORM N-11 (REV. 2025)

Form N-11 (Rev. 2025)

Page 2 of 4
Your Social Security Number

N11_F 2025A 02 VID01

Your Spouse’s SSN

Name(s) as shown on return

ROUND TO THE NEAREST DOLLAR
7 Federal adjusted gross income (AGI) (see page 11 of the Instructions) .......................................
8	 Difference	in	state/federal	wages	due	to	COLA,	ERS,	
etc. (see page 11 of the Instructions) ...................................8
9 Interest on out-of-state bonds
(including municipal bonds) ..................................................9
10	 Other	Hawaii	additions	to	federal	AGI	
(see page 11 of the Instructions) ........................................10
11

Add lines 8 through 10 .................. Total Hawaii additions to federal AGI

▼

IF NEGATIVE, PLACE MINUS SIGN

▼

IF NEGATIVE, PLACE MINUS SIGN

▼

IF NEGATIVE, PLACE MINUS SIGN

7

11

12 Add lines 7 and 11 .........................................................................................................................
13	 Pensions	taxed	federally	but	not	taxed	by	Hawaii
(see page 13 of the Instructions) ........................................13

12

14	 Social	security	benefits	taxed	on	federal	return .................14
15	 First	$8,636	of	military	reserve	or	Hawaii	national	
guard duty pay....................................................................15
16	 Payments	to	an	individual	housing	account .......................16
17	 Exceptional	trees	deduction	(attach	affidavit)	
(see page 14 of the Instructions) ........................................17
18	 Other	Hawaii	subtractions	from	federal	AGI	
(see page 14 of the Instructions) ........................................18
19 Add lines 13 through 18
............................................Total Hawaii subtractions from federal AGI

19

20	 Line	12	minus	line	19 ............................................................................................ Hawaii AGI
CAUTION:

†

20

If you can be claimed as a dependent on another person’s return, see the Instructions on page 15, and place an X here.

21	 If	you	do	not	itemize	your	deductions,	go	to	line	23	below.		Otherwise	go	to	page	15	of	the	Instructions
and enter your itemized deductions here.
21a Medical and dental expenses
(from Worksheet A-1) .......................................................21a

TOTAL ITEMIZED
DEDUCTIONS

21b	 Taxes	(from	Worksheet	A-2) ............................................ 21b
21c

22 Add lines 21a through 21f.
If your Hawaii adjusted gross
income is above a certain
amount, you may not be
able to deduct all of your
itemized deductions. See the
Instructions on page 19. Enter
total here and go to line 24.

Interest expense (from Worksheet A-3) ............................21c

21d	 Contributions	(from	Worksheet	A-4) ................................ 21d
21e	 Casualty	and	theft	losses	(from	Worksheet	A-5) ..............21e
21f	 Miscellaneous	deductions	(from	Worksheet	A-6) ............. 21f
23	 If	you	checked	filing	status	box:	1	or	3	enter	$4,400;	
2	or	5	enter	$8,800;	4	enter	$6,424 ........................................................Standard Deduction † 23
▼

24	 Line	20	minus	line	22	or	23,	whichever	applies.	(This	line	MUST	be	filled	in) ..................

N112N4X7

ID NO 01

IF NEGATIVE, PLACE MINUS SIGN

24

FORM N-11 (REV. 2025)

Form N-11 (Rev. 2025)

Page 3 of 4
Your Social Security Number

N11_F 2025A 03 VID01

25

26
27

27a

28
29
30
31
32

33

Your Spouse’s SSN

Name(s) as shown on return

Multiply $1,144 by the total number of exemptions claimed on line 6e.
If you and/or your spouse are blind, deaf, or disabled, place an X in the applicable box(es),
and see page 20 of the Instructions.
Yourself
Spouse ...............................................................................................

25

Taxable Income. Line 24 minus line 25 (but not less than zero) .................. Taxable Income † 26
Tax. Place an X if from
Tax Table;
Tax Rate Schedule; or
Capital Gains Tax
Worksheet on page 33 of the Instructions.
(
Place an X if tax from Forms N-2, N-103, N-152, N-168, N-312, N-325, N-338,
N-344, N-348, N-405, N-586, N-615, or N-814 is included.) .............................................. Tax † 27
If tax is from the Capital Gains Tax Worksheet, enter
the net capital gain from line 14 of that worksheet ...........27a

Refundable Food/Excise Tax Credit
(attach Form N-311) DHS, etc. exemptions
....28
Credit for Low-Income Household
Renters (attach Schedule X) ..............................................29
Credit for Child and Dependent
Care Expenses (attach Schedule X) ..................................30
Credit for Child Passenger Restraint
System(s) (attach a copy of the invoice) ............................31
Total refundable tax credits from
Schedule CR (attach Schedule CR) ...................................32
Add lines 28 through 32 .................................................................Total Refundable Credits † 33

34

Line 27 minus line 33. If line 34 is zero or less, see Instructions. ....... Adjusted Tax Liability † 34

35

Total nonrefundable tax credits (attach Schedule CR) ..................................................................

Line 34 minus line 35 ................................................................................................. Balance † 36
Hawaii State Income tax withheld (attach W-2s)
(see page 22 of the Instructions for other attachments) ...................37

38

2025 estimated tax payments ............................................38

39

Amount of estimated tax applied from 2024 return ............39

40

Amount paid with extension ...............................................40

41

Add lines 37 through 40 .................................................................................Total Payments † 41

42
43

If line 41 is larger than line 36, enter the amount OVERPAID (line 41 minus line 36) (see Instructions) .
Contributions to (see page 22 of the Instructions): ........................
Yourself
Spouse
43a Hawaii Schools Repairs and Maintenance Fund .....................
$2
$2
43b Hawaii Public Libraries Fund ...................................................
$5
$5
43c Domestic and Sexual Violence / Child Abuse and Neglect Funds .............
$5
$5
Add the amounts of the Xs on lines 43a through 43c and enter the total here .............................

42

45 Line 42 minus line 44 ........................................................................................................

45

N113N4X7

ID NO 01

IF NEGATIVE, PLACE MINUS SIGN

▼

IF NEGATIVE, PLACE MINUS SIGN

35

36
37

44

▼

44

FORM N-11 (REV. 2025)

Form N-11 (Rev. 2025)

Page 4 of 4
Your Social Security Number

Name(s) as shown on return

N11_F 2025A 04 VID01

46

Your Spouse’s SSN

Amount of line 45 to be applied to your

47a

2026 ESTIMATED TAX ......................................................46
Amount to be REFUNDED TO YOU (line 45 minus line 46) If filing late,
see page 23 of Instructions ........................................................................................................... 47a
Place an X in this box if this refund will ultimately be deposited to a foreign (non-U.S.) bank. Do not complete lines 47b, 47c, or 47d.

47b

Routing number

47d
48
49

Account number
AMOUNT YOU OWE (line 36 minus line 41). ...............................................................................
PAYMENT AMOUNT Submit payment online at hitax.hawaii.gov or attach check or
money order payable to “Hawaii State Tax Collector.” ..................................................................

50

47c Type:

Savings

48
49

Estimated tax penalty. (See page 23 of
Instructions.) Do not include on line 42 or 48. Place an X in
this box if Form N-210 is attached †
.....................50

51 Did you file a federal Schedule C?
your main business activity:
your main business product:
52 Did you file a federal Schedule E
for any rental activity?

53 Did you file a federal Schedule F?
your main business activity:
your main business product:
DESIGNEE

Checking

Yes

No
If yes, enter Hawaii gross receipts
,
, AND your HI Tax I.D. No. for this activity GE

Yes

No

Yes

No
If yes, enter Hawaii gross receipts
,
, AND your HI Tax I.D. No. for this activity GE

If yes, enter Hawaii gross rents received
AND your HI Tax I.D. No. for this activity GE

If designating another person to discuss this return with the Hawaii Department of Taxation, complete the following. This is not a full power of
attorney. See page 25 of the Instructions.

Designee’s name †
HAWAII ELECTION
CAMPAIGN FUND

Â

Phone no. †
Indicate if you want $3 to go to the Hawaii Election Campaign Fund.
If joint return, indicate if your spouse designates $3 to the fund.

Identification number †
Yes
Note: Placing an X in the “Yes” box
will not change your tax or refund.
Yes

(See page 25 of the Instructions)
DECLARATION — I declare, under the penalties set forth in section 231-36, HRS, that this return (including accompanying schedules or statements) has been examined by me and, to the best
of my knowledge and belief, is a true, correct, and complete return, made in good faith, for the taxable year stated, pursuant to the Hawaii Income Tax Law, Chapter 235, HRS.

Your signature

PLEASE
SIGN HERE

Please print & sign. Do not use e-Signature.
†	
Your Occupation

Date

Daytime Phone Number

N114N4X7

†

Your Spouse’s Occupation
Date

Preparer’s
Signature †
Paid
Preparer’s
Information

Spouse’s signature (if filing jointly, BOTH must sign)

Date

Daytime Phone Number

Preparer Tax Identification Number (PTIN)
Federal Employer Identification Number (FEIN)

Print
Preparer’s Name †
Firm’s name (or yours
†
if self-employed),
Address, and ZIP Code

Telephone Number

ID NO 01

FORM N-11 (REV. 2025)

SCHEDULE CR
(REV. 2025)

2025

SCHEDULE OF TAX CREDITS
or other tax year beginning

SCHCR_F 2025A 01 VID01

and ending

Attach this schedule directly behind Form N-11, N-15,
N-30, N-40 or N-70NP

Name(s) as shown on return

PART I

TAX YEAR

STATE OF HAWAII—DEPARTMENT OF TAXATION

SSN(s) or Federal Employer I.D. No.

Refundable Tax Credits

1

Capital Goods Excise Tax Credit (attach Form N-312) .................................................................................

1

2

Fuel Tax Credit for Commercial Fishers (attach Form N-163) .......................................................................

2

3

Motion Picture, Digital Media, and Film Production Income Tax Credit (attach Form N-340) .......................

3

4

Place an X in the appropriate box for the type of energy system installed and placed in service:

Solar

Wind

Renewable Energy Technologies Income Tax Credit (For Systems Installed and
Placed in Service on or After July 1, 2009) (attach all Form(s) N-342) .........................................................

4

5	 Important	Agricultural	Land	Qualified	Agricultural	Cost	Tax	Credit	(attach	Form	N-344) ..............................

5

6

Tax Credit for Research Activities (attach Form N-346) ................................................................................

6

7

Renewable Fuels Production Tax Credit for Tax Years After December 31, 2021 (attach Form N-360) .......

7

8

Earned Income Tax Credit (attach Form N-356) ...........................................................................................

8

9 Claim of Right Tax Credit (attach Form N-364) .............................................................................................
10 Other refundable credits
a. Pro rata share of taxes withheld and paid by a
partnership or S corporation on the
sale of Hawaii real property interests ............................ 10a

9

b.
c.
11

Credit From a Regulated Investment Company ............ 10b
Add lines 10a and 10b...........................................................................................................................

10c

Total Refundable Credits. Add lines 1 through 9 and line 10c. Enter here and on Form N-11, line 32;
N-15, line 49; N-30, line 12; N-40, Schedule G, line 2; or N-70NP, line 18.
Attach this schedule directly behind your Form N-11, N-15, N-30, N-40 or N-70NP. ...................................

11

PART II

Nonrefundable Tax Credits

12	 Income	tax	paid	to	another	state	or	foreign	country	(N-11,	N-15,	N-40,	and	N-70NP	filers)	(Attach
copy of tax return(s) from other state(s) or federal Form(s) 1116. See Instructions for Schedule CR
for more information.) ....................................................................................................................................

12

13

13

Enterprise Zone Tax Credit (attach Form N-756) ..........................................................................................
Column (a)
Total Unused Carryover
Credit from Prior Tax Year

14

Column (c)
Total Credit Applied
to 2025 Tax Year

Column (d)
Unused Credit to Carryover
to 2026 Tax Year

Carryover of the Credit for Energy Conservation (attach Form N-323)
14

SCR1N4X7

ID NO 01

SCHEDULE CR (REV. 2025)

SCHEDULE CR
(REV. 2025)

Page 2

Name(s) as shown on return

SCHCR_F 2025A 02 VID01

15

SSN(s) or Federal Employer I.D. No.

Column (a)
Total Unused Carryover
Credit from Prior Tax Year

Column (c)
Total Credit Applied
to 2025 Tax Year

Column (d)
Unused Credit to Carryover
to 2026 Tax Year

Carryover of the High Technology Business Investment Tax Credit (attach Form N-323)
15

16

Carryover of the Cesspool Upgrade, Conversion or Connection Income Tax Credit (attach Form N-323)
16

17

Carryover of the Technology Infrastructure Renovation Tax Credit (attach Form N-323)
17

18

Carryover of the Hotel Construction and Remodeling Tax Credit (attach Form N-323)
18

19

Carryover of the Residential Construction and Remodeling Tax Credit (attach Form N-323)
19

20

Carryover Renewable Energy Technologies Income Tax Credit (For Systems Installed & Placed in Service Before July 1, 2009) (attach Form N-323)
20

21

Carryover of the Organic Foods Production Tax Credit (attach Form N-323)
21

22

Carryover of the Renewable Fuels Production Tax Credit (For Tax Years Before January 1, 2022) (attach Form N-323)
22

23

Carryover of the Capital Infrastructure Tax Credit (attach Form N-348)
23

24

Carryover of the Earned Income Tax Credit (attach Form N-356)
24
Column (a)
Total Unused Carryover
Credit from Prior Tax Year

25

Column (b)
Total New Credit Claimed
for 2025 Tax Year

Column (c)
Total Credit Applied
to 2025 Tax Year

Column (d)
Unused Credit to Carryover
to 2026 Tax Year

Tax Credit for Low-Income Housing (attach Form N-586)
25

26

Credit for Employment of Vocational Rehabilitation Referrals (attach Form N-884)
26

SCR2N4X7

ID NO 01

SCHEDULE CR (REV. 2025)

SCHEDULE CR
(REV. 2025)

Page 3

Name(s) as shown on return

SSN(s) or Federal Employer I.D. No.

SCHCR_F 2025A 03 VID01

Column (a)
Total Unused Carryover
Credit from Prior Tax Year
27

Column (b)
Total New Credit Claimed
for 2025 Tax Year

Column (c)
Total Credit Applied
to 2025 Tax Year

Column (d)
Unused Credit to Carryover
to 2026 Tax Year

Credit for School Repair and Maintenance (attach Form N-330)
27

28

Nonrefundable Renewable Energy Technologies (For systems Installed and Placed in Service on or After July 1, 2009) (attach all Form(s) N-342)
Place an X in the appropriate box for the type of energy system installed and placed in service:
Solar
Wind
28

29

Healthcare Preceptor Income Tax Credit (attach Form N-358)
29

30

Historic Preservation Income Tax Credit (attach Form N-325)
30

31

Nonrefundable Renewable Fuels Production Tax Credit (For Tax Years Beginning After December 31, 2021) (attach Form N-360)
31

32

Pass-Through Entity Tax Credit (attach Form N-362)
32

33

Total Nonrefundable Credits. Add lines 12 and 13 and Column (c) of lines 14 through 32.
Enter here and on Form N-11, line 35; N-15, line 52; N-30, line 14; N-40, Schedule G, line 4; or
N-70NP, line 20. Attach this schedule directly behind your Form N-11, N-15, N-30, N-40 or N-70NP.

SCR3N4X7

ID NO 01

33

SCHEDULE CR (REV. 2025)

SCHEDULE X

STATE OF HAWAII — DEPARTMENT OF TAXATION

2025

TAX CREDITS FOR HAWAII RESIDENTS

(FORM N-11/N-15)
(REV. 2025)

Both pages of Schedule X must be attached
to Form N-11 or N-15

SCHX_I 2025A 01 VID01

Name(s) as shown on Form N-11 or N-15

Your social security number

PART I: CREDIT FOR LOW-INCOME HOUSEHOLD RENTERS

1 Is your adjusted gross income (Form N-11, line 20; or Form N-15, line 35, Column A) less than $30,000?
If “No,” STOP. You cannot claim this credit. If “Yes,” go to line 2.
2 Are you a resident who was present in Hawaii more than nine months in 2025? If “No,” STOP. You cannot claim this credit. If “Yes,” go to line 3.
3 Can you be claimed as a dependent by another taxpayer? If “Yes,” STOP. You cannot claim this credit. If “No,” go to line 4.
4 Enter required information for each rental unit that was fully subject to real property tax. Do not list rental units that were wholly or partially exempt from real property tax. If you occupied
more than one qualified unit, submit the required information for each additional unit on a separate sheet. If you shared the unit with others, enter only your share of the rent.
Address (give Apt. No., if any)
Occupied From
, 2025, To
, 2025. Total rent paid for this period. $ ______________
month
month
Owned by (or agent for owner)

5
6
7
8

name

GE __ __ __ - __ __ __ - __ __ __ __ - __ __
(Hawaii Tax I.D. No.)

address

Add up your share of rent paid during the taxable year for all the units you have listed. .............................................
5
6
Enter the amount of your exclusions (e.g., utilities, parking stalls, ground rent, rental subsidies such as public assistance). .....
Line 5 minus line 6. If this amount is $1,000, or less, STOP. You cannot claim this credit.........................................
7
List YOURSELF, YOUR SPOUSE, AND YOUR DEPENDENTS that meet all of the following: a) Resident of Hawaii, b) Present
in Hawaii for more than nine months in 2025, and c) Cannot be claimed as a dependent by another taxpayer.
Include minor children receiving more than half of their support from public agencies which you can claim as dependents.
Name

8

Relationship
Self
Spouse

Relationship

Name

Enter	the	number	of	qualified	persons	listed	above................................................................................................................................. 8
9	 If	you	are	a	qualified	exemption	and	you	are	age	65	or	over,	enter	1.	Otherwise,	enter	-0-. ................................................................... 9
10	 If	you	are	married	filing	jointly	or	married	filing	separately	where	your	spouse	is	not	filing	a	Hawaii
return,	had	no	income,	and	was	not	the	dependent	of	someone	else;	and	your	spouse	is	a	qualified	
exemption; and your spouse is age 65 or over; enter 1. Otherwise, enter -0-. ................................................................................................. 10
11 Add lines 8 through 10. ............................................................................................................................................................................ 11
12 Multiply the number of exemptions on line 11 by $50 and enter the result here and on Form N-11, line 29;
or Form N-15, line 46. This is your credit for low-income household renters. (Whole dollars only).............................. 12

PART II: CREDIT FOR CHILD AND DEPENDENT CARE EXPENSES

00

You	cannot	claim	a	credit	for	child	and	dependent	care	expenses	if	your	filing	status	is	married	filing	separately	unless	you	meet	the	requirements	listed
in the instructions under “Married Persons Filing Separately.” If you meet these requirements, check this box.

Section A:

Care Provider Information

Complete line 1 columns (a) through (e) for each person or organization that provided the care. If you do not give the information asked for in each column,
or	if	the	information	you	give	is	not	correct,	your	credit	and,	if	applicable,	the	exclusion	of	employer-provided	dependent	care	benefits	may	be	disallowed.
(a) Care
(b)	Address
(c) Identification	number
(d) Hawaii	Tax
(e)	Amount	paid
1
provider’s name
(number, street, city, state, and Postal/ZIP code)
(SSN or FEIN)
I.D. No.
GE __ __ __ - __ __ __ - __ __ __ __ - __ __

GE __ __ __ - __ __ __ - __ __ __ __ - __ __

Section B:

Dependent Care Benefits —	(If	you	did	not	receive	dependent	care	benefits,	skip	to	line	21)
2	 Enter	the	total	amount	of	dependent	care	benefits	you	received	in	2025.	Amounts	you	received	as	an	employee	
should be shown in Box 10 of your federal Form(s) W-2. If you were self-employed or a partner, include amounts
you received under a dependent care assistance program from your sole proprietorship or partnership. ...................
3 Enter the amount, if any, you carried over from 2024 and used in 2025 during the grace period. ...............................
4 Enter the amount, if any, you forfeited or carried forward to 2026. (See the Instructions)............................................
5 Combine lines 2 through 4. ...........................................................................................................................................

SCX1N4X7

ID NO 01

2
3
4
5

(

)

SCHEDULE X (REV. 2025)

SCHEDULE X (FORM N-11/N-15) (REV. 2025)

PAGE 2

Name(s) as shown on Form N-11 or N-15

Your social security number

SCHX_I 2025A 02 VID01

6
7
8
9	

10	
11	
12	

13
	14	
15
16
17	
18	
19	

Enter the total amount of qualified expenses incurred in 2025 for the care of the qualifying person(s). ...
6
Enter the smaller of line 5 or 6. .....................................................................................
7
Enter your earned income. (See the Instructions) ........................................................
8
If	married	filing	jointly,	enter	your	spouse’s	earned	income	(if	you	or	your	spouse	
was	a	student	or	disabled,	see	the	Instructions);	if	married	filing	separately,	
see	the	Instructions;	all	others,	enter	the	amount	from	line	8. ......................................
9
Enter	the	smallest	of	line	7,	8,	or	9. ..............................................................................
10
Enter	$5,000	($2,500	if	married	filing	separately	and	you	were	required	to	enter	your	
spouse’s	earned	income	on	line	9). ..............................................................................
11
Is	any	amount	on	line	2	from	your	sole	proprietorship	or	partnership?
No. Enter -0-.
Yes. Enter the amount here. ..............................................................................................................................................
Line 5 minus line 12 ......................................................................................................
13
Deductible	benefits.	Enter	the	smallest	of	line	10,	11,	or	12.	Also,	include	this	amount	on	the	appropriate	line(s)	of	
your return. ........................................................................................................................................................................
Excluded	benefits.	If	line	12	is	zero,	enter	the	smaller	of	line	10	or	11.	Otherwise,	subtract	line	14	from	the	smaller	of	
line	10	or	11.	If	zero	or	less,	enter	-0-. ...............................................................................................................................
Taxable	benefits.	Line	13	minus	line	15.	If	zero	or	less,	enter	-0-.	Also,	include	this	amount	on	Form	N-15,	line	7.	
On	the	dotted	line	next	to	line	7,	write	“DCB.”	(Form	N-11	filers,	see	the	Instructions) .....................................................
Enter	$10,000	($20,000	if	two	or	more	qualifying	persons) ...............................................................................................
Add	lines	14	and	15.	 .........................................................................................................................................................
Line	17	minus	line	18.		If	zero	or	less,	STOP. You cannot take the credit. Exception.		If	you	paid	2024	expenses	in	
2025,	see	the	Instructions	for	line	28. ................................................................................................................................

12

14
15
16
17
18
19

20	 Complete	line	21.	Do	not	include	in	column	(e)	any	benefits	shown	on	line	18.	Then,	add	the	amounts	in	column	(e)	
and enter the total here...................................................................................................................................................... 20
Section C: Credit for Child and Dependent Care Expenses —	(Generally,	married	persons	must	file	a	joint	return	to	claim	the	tax	credit.)
(e) Qualified	expenses
21	
(a) Qualifying	person’s	name
(b) Date	of	Birth
(c) Grade
(d) Qualifying	person’s	social
you	incurred	and	paid
(mm/dd/yyyy)
(pre-K	to	12)	
security	number	
in	2025	for	the	person
listed in column (a)

22	 Add	the	amounts	in	column	(e)	of	line	21.	Do	not	enter	more	than	$10,000	for	one	qualifying	person	or	$20,000	for	two	
or	more	persons.	If	you	completed	Section	B,	enter	the	smaller	of	line	19	or	20. ....................................................................
23 Enter your earned income. (See the Instructions) .............................................................................................................
24	 If	married	filing	jointly,	enter	your	spouse’s	earned	income	(if	you	or	your	spouse	was	a	student	or	disabled,	
see	the	Instructions);	all	others,	enter	the	amount	from	line	23 .........................................................................................
25	 Enter	the	smallest	of	line	22,	23,	or	24. .............................................................................................................................
26	 Enter	your	adjusted	gross	income	from	Form	N-11,	line	20;	or	Form	N-15,	line	35,	
Column	A ......................................................................................................................
26
27	 Enter	on	line	27	the	decimal	amount	shown	below	that	applies	to	the	amount	on	line	26.
If line 26 is:
	 Under	$25,001	
	$25,001	–	30,000	
	$30,001	–	35,000	
	$35,001	–	40,000	

Decimal amount is:
.25
.24
.23
.22

If line 26 is:
	$40,001	–	45,000	
	$45,001	–	50,000	
	$50,001	and	over	

24
25

Decimal amount is:
.21
.20
.15
27

28	 Multiply	line	25	by	the	decimal	amount	on	line	27.	If	you	paid	2024	expenses	in	2025,	see	the	Instructions.	
Enter	the	result	here	and	on	Form	N-11,	line	30;	or	Form	N-15,	line	47.	This	is	your	credit	for	child	and	
dependent	care	expenses.	(Whole	dollars	only)................................................................................................................

SCX2N4X7

22
23

ID NO 01

28

X

00

SCHEDULE X (REV. 2025)