Form S-1040x - Amended Individual Income Tax Return - Springfield (Page 2 of 2) in pdf

S-1040X, Page 2

Part I

Exemptions

Complete only if a change in exemptions

A. Number

C. Corrected

originally

B. Net Change

number

reported

1 Exemptions – yourself and spouse..........................................................................................................

2 Your dependent children who lived with you ...........................................................................................

3 Other dependents....................................................................................................................................

4 Total Exemptions (add lines 1 through 3)................................................................................................

5 Multiply the total number of exemptions claimed by $1,500.00 for 1999 and after, $600.00 for 1998

and prior years.

6 Enter first names of your dependent children who lived with you, but were not claimed on original return:

Enter number

7 Other dependents not claimed on original return:

(d) Did dependent

(e) Did you provide

of months

have income

more than one-half

lived in your

of $1,000 or

of dependent's

(a) Name

(b) Relationship

home

more?

support:

Enter number

Part II

Explanation of Changes to Income, Deductions, and Credits

Enter the line reference from page 1 for which you are reporting a change and

give the reason for each change. Attach applicable schedules.

INSTRUCTIONS FOR FILING THE AMENDED RETURN

Lines 1 through 11 in column A should appear the same as they were last (as originally filed, as corrected by Springfield or as last amended).

Column B should contain only the amount to be added or subtracted from that particular line. Column C should contain the correct amount.

All amounts appearing in column B must be explained on page 2, part II AND MUST HAVE ALL SUPPORTING DOCUMENTATION

ATTACHED FOR VERIFICATION, this includes but is not limited to the following: A copy of the Federal 1040X, IRS letter of adjustment,

additional and or corrected schedules, forms, work-sheets, etc.

If you need assistance in preparing your Springfield return, you may come into our office at 601 Avenue A, Springfield, MI 49015-1499 or call

us at 616-965-8324. Office hours are 8:00 am to 5:00 pm, Monday through Friday.

Sign Here

Taxpayer's signature

Date

Signature of preparer other than taxpayer

Date

Sign Here

Spouse's signature

Date

Address and phone number

Mail completed return to: City of Springfield, Income Tax Department, 601 Avenue A, Springfield, MI 49015-1499

(Make checks payable to: CITY TREASURER)

Form S-1040x - Amended Individual Income Tax Return - Springfield Page 2

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