A nonrefundable credit is provided for a fraction of eligible expenses incurred for the care of qualifying children or dependents, with the intention of facilitating the taxpayer (and their spouse, if filing jointly) to engage in gainful employment. The following details are necessary for assessing your eligibility for this credit. All information must be provided without exception.

Please note: This form is not a replacement for original receipts and transaction records with the institution specified. You are responsible for maintaining accurate records in a secure and easily accessible location for a minimum of three years. Completion of this form by us (the firm) does not imply any assurance of deduction or credit eligibility.

The information provided herein is, to the best of my knowledge, accurate and valid. I acknowledge that I am solely accountable for the contents reported on my income tax return.