Form Al-1040x - Amended Albion Income Tax Return Page 2

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PART 6 - EXEMPTIONS. Check a box for all that apply (see instructions).
31. Show exemptions claimed on your original return
32. Show exemptions claimed on this return.
You
Spouse
You
Spouse
Federal exemption for self
Federal exemption for self
Age 65 or older
Age 65 or older
33. List all your dependents and answer all questions for each dependent (D-G answer 'yes' or 'no'. Attach separate sheet if necessary
A
B
C
D
E
F
G
Dependent's Name
Social Security
Relationship
Did the dependent
Did you provide
Did the dependent
Was this dependent
Number
file a federal return
more than half the
live with you more
claimed on your
and claim exemption
dependent's
than 6 months during
original return?
for self?
support?
the year?
34. Explain change in number of dependents; attach sheet if more room is needed.
PART 7 - EXPLANATION of CHANGES
35.
Explain changes to income, deductions and credits. Show computations in detail and attach applicable schedules.
PART 8 - DECLARATIONS - Sign below. If filing jointly, both husband and wife must sign.
I declare, under penalty of perjury, that this return is
I declare, under penalty of perjury, that the information in this return and attachments is
based on all information of which I have knowledge.
true and complete to the best of my knowledge.
I authorize Albion to discuss my return and
Do not discuss my return with
Preparer's Signature, Address, Phone and ID No.
attachments with my preparer.
my preparer.
Filer's Signature
Date
Spouse's Signature
Date
Forms may be obtained on the internet at
or by calling (517)629-7865
Mailing
Refund
Pay
Mail your return to:
Make checks payable to "City of Albion" and record
Instructions
City of Albion
last four digits of your Social Security number, the
Income Tax Division
tax year(s) and the words "amended Albion income
112 W. Cass St.
tax" on the front of the check. Mail check and return
Albion, MI 49224
to the City of Albion at the address shown to the left.
AL-1040X page 2 (rev 6/06)

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