OMB No. 1545-0074
                                               Qualified Adoption Expenses
Form  8839
                                                 Attach to Form 1040, 1040-SR, or 1040-NR. 
Department of the Treasury            Go to www.irs.gov/Form8839 for instructions and the latest information.                   Attachment  2022
Internal Revenue Service                                                                                                        Sequence No. 38
Name(s) shown on return                                                                                        Your social security number

Part I        Information About Your Eligible Child or Children—You must complete this part. 
              See instructions for details, including what to do if you need more space.
                                                                         Check if child was—                                                  (g) 
1                           (a)                       (b)            (c)          (d)        (e)                 (f)                 Check if 
                         Child’s name              Child’s year   born before   a child    a foreign           Child’s               adoption     
                                                   of birth       2005 and    with special   child           identifying number became final in 
              First                     Last                      disabled      needs                                           2022 or earlier 
Child 
1
Child 
2
Child 
3
Caution: If the child was a foreign child, seeSpecial rules in the instructions for line 1, column (e), before you complete Part II or 
Part III. If you received employer-provided adoption benefits, complete Part III on the back next.
Part II    Adoption Credit
                                                                              Child 1        Child 2         Child 3
2     Maximum  adoption  credit  per  child.  Enter  $14,890 
      (see instructions)  .      .    . . .  . . . .  .    .    .    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)  .         .    5 
      Caution: Your qualified adoption expenses may not 
      be equal to the adoption expenses you paid in 2022.
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 $223,410?
           No.    Skip lines 8 and 9, and enter -0- on line 10.
           Yes.   Subtract $223,410 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 prior years. See your Adoption Credit Carryforward Worksheet in the
      2021 Form 8839 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 Schedule 3 (Form 1040), line 6c. If
      line 15 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 (2022) 

Form 8839 (2022)                                                                                                           Page 2 
Part III Employer-Provided Adoption Benefits
                                                                       Child 1          Child 2     Child 3
17 Maximum  exclusion  per  child.  Enter  $14,890  (see 
   instructions)  . .      . . . . .   . .   . .   . .      .      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 
   2022. This amount should be shown in box 12 of your 
   2022 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 2022, 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 $223,410?
         No.     Skip lines 24 and 25, and enter -0- on line 26.
         Yes.    Subtract $223,410 from line 23  . . .      .    . . .   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 1f of Form 1040, 1040-SR, or 1040-NR. 
                                                                                          . .   . . . . .  29
         Yes. Subtract line 21 from line 28. Enter the result as a negative number. 
                 Also, enter the result on line 1f of Form 1040, 1040-SR, or 1040-NR.   }

         You may be able to claim the adoption credit in Part II on the front of this form if any of the following apply.  
TIP      • You paid adoption expenses in 2021, those expenses were not fully reimbursed by your employer or otherwise, and 
                 the adoption was not final by the end of 2021.  
         • The total adoption expenses you paid in 2022 were not fully reimbursed by your employer or otherwise, and the 
                 adoption became final in 2022 or earlier.  
         • You adopted a child with special needs and the adoption became final in 2022.
                                                                                                             Form 8839 (2022)