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Department Use Only
Form (MM/DD/YY)
MO-ATC Adoption Tax Credit Claim

Taxable Year Beginning Ending
(MM/DD/YY) (MM/DD/YY)

Adoptive Social Security
Father’s
Name Number

Adoptive Social Security
Mother’s
Name Number

Business
Name

Missouri Tax I.D. Federal Employer
Number I.D. Number

Charter NAICS Code
Number (if applicable)

Part A - Tax Credit Claimant Information
Address City

Telephone
State ZIP Number

Tax Type
       Individual            Corporation            Non-Profit           Other 

Name of Social Security 
Adopted Number  
Child (If Available)
State or Birthdate of  
Age of Country of Child 
Child Origin (MM/DD/YY)

Date Child Was Placed in Date Adoption Became 
the Home (MM/DD/YY) Final (MM/DD/YY)

Select the appropriate box:
Credit for placed in the home Credit for adoption finalized

1)   Was the child a resident or ward of a resident of Missouri at the time the adoption was initiated? ............................................           Yes           No 

2)  Is the adopted child special needs? See definition on Page 3. ...................................................................................................           Yes          No 
Part B - Adopted Child Information
3) Was the special needs adopted child 18 years of age or over on the date the adoption was final?  .............................................  Yes          No
Note:  If yes, you must attach a statement from the child’s physician indicating that the child is physically or mentally incapable of caring for his or 
herself and living independently of the adoptive parents.

4)  Name any other state or federal program utilized for the adoption of a child. .....................

                                                                                                                                                                                                                                                         Paid by Adoptive Parent(s)     Paid by Employer
                                                                               1. Adoption fees ................................................................................................................................................         1                        00 1                  00
                                                                               2. Court costs ....................................................................................................................................................       2  +                     00 2   +              00
                                                                               3. Attorney fees .................................................................................................................................................        3  +                     00 3   +              00
                                                                               4. Other directly related expenses ....................................................................................................................                   4  +                     00 4   +              00
                                                                               5. Total nonrecurring expenses
                                                                                                                             (Employers claiming the credit, enter total on Line 5 and then skip to Line 11.) .......................................... 5  =                     00 5   =              00
                                                                               6. Amount of nonrecurring expenses paid by Missouri Children’s Division ......................................................                                            6  +                     00
                                                                               7. Amount of nonrecurring expenses paid by employer ...................................................................................                                   7  +                     00
                                                                               8. Amount of federal adoption tax credit claimed from Federal Form 8839  .....................................................                                            8  +                     00
                                                                               9. Amount received from other federal, state, or local government programs ..................................................                                             9                        00
                                                                               10. Add Lines 6 through 9 and enter on Line 10. ................................................................................................  10  =                                            00
                                                                               11. Subtract Line 10 from Line 5 and enter the amount on Line 11.  (Employer enter amount from Line 5.) .....  11  =                                                                               00 11   =             00
Part C - Nonrecurring Adoption Expenses                                        12. The adoption tax credit is limited to the lesser of the total on Line 11 or $10,000.
                                                                                                                             Enter the smaller amount on Line 12. ...........................................................................................................  12 00 12                 00

                                                                                                                             I hereby certify, to the Department of Revenue, that the adoption expenses itemized in Part C of this schedule have not and will not be reimbursed and paid from 
                                                                                                                             funds available from the state of Missouri, managed by the Missouri Department of Social Services, Children’s Division.  

                                                                                                                             Authorized 
                                                                                                                             Signature                                                           Title
                                        Part D - Social 
                                                                               Services Certification                        Children’s Division                                                 Date
                                                                                                                             County Office                                                       (MM/DD/YY)

                                                                                                                             Only complete Part E for special needs adoptions.
                                                                                                                             I  certify  that  the  adopted  child  meets  the  necessary  criteria  and  is  determined  to  be  a  “special  needs  child”  pursuant  to           Section  135.326,  RSMo.  
                                                                                                                             (Part E may be shared by: (1) The Missouri Department of Social Services, Children’s Division, or (2) A child placing agency licensed by the state of Missouri, or 
                                                                                                                             (3) A court of competent jurisdiction.)

                                                                                                                             Authorized 
                                                                                                                                                                                                 Date
                                                                                                                             Signature                                                           (MM/DD/YY)
                                                        Part E - Special Needs                        Certification by Agency

                                                                                                                             Office of
                                                                               Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. I am aware of the applicable reporting 
                                                                               requirements of Section 135.805, RSMo and the penalty provisions of Section 135.810, RSMo.
                                                        Adoptive                                                                                                                                 Date
                                                        Father’s 
                                                        Signature                                                                                                                                (MM/DD/YY)

                                                        Adoptive Mother’s                                                                                                                        Date
                                                        Signature                                                                                                                                (MM/DD/YY)
Signature(s)                                            Name of 
                                                        Business Agent 
                                                        or Contact

                                                        Telephone
                                                        Number
                                                                                                                             This form must be attached to the Miscellaneous Income Tax Credits (Form MO-TC), along with your tax return.
Pursuant to Section 105.1500, RSMo, the Department of Revenue is prohibited from requiring any entity exempt from federal income tax under Section 501(c) of the Internal Revenue Code, or any individual, to 
provide the Department with any list, record, register, registry, roll, roster, or other compilation of data of any kind that directly or indirectly identifies a person as a member, supporter, volunteer of, or donor of finan-
cial or nonfinancial support to, any entity exempt from federal income tax under Section 501(c) of the Internal Revenue Code. Nothing in this form should be read or understood as a requirement that you provide 
any such information. Notwithstanding any publication, webpage, form, instruction, regulation, or statement shared by the Department, you are not required to include such information on this form. If you encounter 
any technical difficulty in submitting this form without including information that you believe is protected by Section 105.1500, RSMo, feel free to contact the Department by email at corporate@dor.mo.gov or by 
phone at 573-751-4541.
                                                                                                                                                                                                                                                                                  Form MO-ATC (Revised 12-2022)
Taxation Division                                                                                                                                Phone: (573) 751-3220 
 Individual Income Tax                                                                                                                           TTY: 1-800-735-2966 
                                                                                                                                                                               Ever served on active duty in the United States Armed Forces?  
P.O. Box 27                                                                                                                                      Fax: (573) 522-8619           If yes, visit dor.mo.gov/military/ to see the services and benefits we offer to all 
Jefferson City, MO 65105-0027                                                                                                                    E-mail:  taxcredit@dor.mo.gov eligible military individuals. A list of all state agency resources and benefits can be 
Visit dor.mo.gov/tax-credits/atc.html for additional information.                                                                                                              found at veteranbenefits.mo.gov/state-benefits/.

                                             General Instructions - Adoption Tax Credit
 Individuals  and  business  entities  may  claim  a  tax  credit  for  their  total           the adoption tax credit is claimed. You may be eligible to claim 
 nonrecurring adoption expenses. Missouri residents may claim up to                            an  additional  federal  adoption  tax  credit  in  subsequent  years,  which 
 $10,000 per child. You may claim 50% of the credit in the year the child                      will reduce your Missouri adoption tax credit and may result in a billing. 
 is placed in the home and 50% of the credit may be claimed at the time                        When first claiming the credit as the result of a sale or assignment, attach 
 the adoption is finalized.  If the amount of credit claimed exceeds the tax                   a completed  Form MO-TF  and a  copy  of the original Form MO-ATC 
 liability, the remaining credit may be claimed on the subsequent 4 years.                     completed by the adoptive parents, as well as Part A of the revised form. 
 This credit is non-refundable.                                                                If the Adoption Tax Credit is sold, it must be sold for 75% of the value or 
 The cumulative amount of adoption tax credits claimed by all taxpayers                        greater.
 may not exceed $6 million in any fiscal year, per Section 135.327 RSMo.                       Due Date:
 If the cumulative amount of credits claimed exceed the limitation, priority                   To claim the ATC you must file your return between July 1 and April 15 
 shall be given to applications to claim the tax credit for special needs                      of each fiscal year. In order to claim the Adoption Tax Credit you must 
 children who are residents or wards of residents of this state at the time                    provide Federal Form 1040, Federal Form 8839, Form MO-TC, and Form 
 the adoption is initiated.                                                                    MO-ATC.
 Special Needs Child:                                                                          Missouri Revised Statutes 135.325 through 135.339 do not provide 
 A child for whom it has been determined by the Missouri Department                            provisions to waive interest and penalties due to the apportionment of the 
 of Social Services, Children’s Division, a child-placing agency licensed                      Adoption Tax Credit.
 by the state, or a court of com petent jurisdiction to be a child who has a                   If your return would result in a balance due without considering the appli-
 specific factor or condition such as age, membership in a sibling group,                      cation of the Adoption Tax Credit, the Department recommends paying 
 medical condition or diagnosis, or disability because of which it is reason-                  the amount of tax covered by the Adoption Tax Credit by the return due 
 able to conclude that such child cannot be easily placed with adoptive                        date  to  avoid  the  accrual  of  interest  and  penalties  on  the  unpaid  tax. 
 parents.                                                                                      Once the Adoption Tax Credit is apportioned for the fiscal year, any 
 Claim the Adoption Tax Credit:                                                                amount of payment not due to the Department will be refunded.
 Attach Form MO-ATC and      Form MO-TC to the tax return each year  
                                                                               Instructions
                                   Part A                                                      credit enter total on Line 5 and then skip to Line 11.
 Enter the tax credit claimant information, address and select the correct                     Line 6:  Enter the amount paid by the Missouri Department of Social 
 tax type.                                                                                     Services, Children’s Division.
                                                                                               Line 7:  Enter the amount paid by your employer.
                                   Part B
 Enter the adopted child’s information and provide answers to the                              Line 8:  Enter the amount of adoption tax credit claimed from Federal 
 questions by selecting each appropriate box.                                                  Form 8839, Line 16 for specified child. 
                                                                                               Line 9:  Enter the amount of nonrecurring adoption expenses paid from 
                                   Part C                                                      any funds received under any federal, state, or local government programs. 
 Enter the nonrecurring  adoption  expenses  incurred by the adoptive                          Line 10:  Add Lines 6 through 9 and enter the amount on Line 10.
 parents or the employer (up to $10,000). Nonrecurring adoption 
 expenses include:  reasonable and necessary adoption fees, court costs,                       Line 11:  Subtract the amount on Line 10 from the amount on Line 5.  
 attorney  fees,  and  other  expenses  which  are  directly  related  to  the                 Enter the amount on Line 11.  (Employer enter amount from Line 5.)  If 
                                                                                               Line 10 exceeds the amount on Line 5, enter zero (0) on Line 11.
 adoption of a child and are not incurred in violation of federal,             state, or 
 local  laws.  Section  135.815,  RSMo,  requires  the  Department  to                         Line 12:  The adoption tax credit is limited to the lesser of the total on 
 reduce the credit by any in come, sales, use, or insurance tax delinquency                    Line 11 or $10,000.  Enter the smaller amount on Line 12.
 including interest and penalties.                                                                                           Part D
 Line 1:  Enter the total amount of the reasonable and necessary adoption                      The Missouri Department of Social Services, Children’s Division must 
 fees incurred.                                                                                certify the adoption expenses in Part C will not be reimbursed from 
 Line 2:  Enter the total amount of court costs associated in the adoption of                  funds available under any federal, state, or local government programs. 
 the child.                                                                                                                  Part E
 Line 3:  Enter the total amount of attorney fees associated in the adoption                   This section is only completed when the agency is certifying the child 
 of the child.                                                                                 meets the criteria as a special needs child. If the credit is claimed upon 
                                                                                               placement of the child, this certification will be completed and submitted 
 Line 4:  Enter the total amount of other directly related expenses (which                     at that time and does not need to be resubmitted when the adoption is 
 are not in violations of federal, state, or local government laws.)                           final or when the remainder of the credit is claimed.
 Line 5:  Add Lines 1 through 4 and enter the amount on Line 5. This is the                    If you require additional information, you may call the Missouri Department 
 total amount of nonrecurring adoption expenses. Employers claiming the                        of Revenue at (573) 751-3220 or e-mail: taxcredit@dor.mo.gov.
                                              Adoption Tax Credit Worksheet
                                   Use the Adoption Tax Credit Worksheet to track your available credit.
                                                                               1st Year        2nd Year            3rd Year              4th Year           5th Year
A.  Tax liability..............................................................
B.  Amount claimed......................................................
                                                                               Amount From     Ending Balance      Ending Balance      Ending Balance    Ending Balance
                                                                               MO-ATC, Part C, (1st Year Line F) (2nd Year Line F)     (3rd Year Line F) (4th Year Line F)
                                                                               Line 12
C.  Beginning balance ..................................................                
D.  Amount allowed by Department of Revenue...........
E.  Credit sold or transferred.........................................
F.  Ending balance (Line C less Line D, and Line E) ....
                                                                                                                                                     Form MO-ATC (Revised 12-2022)