Form It-40x - Indiana Amended Individual Income Tax Return Form
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1
2Indiana Amended Individual Income Tax Return
Form
Tax
IT-40X
Year
If you are not filing for the calendar year January 1 through December 31, enter period from:
State Form 44405
(R8 / 9-09)
/
/
/
/
to:
Your Social
Spouse’s Social
Security Number
Security Number
Your first name
Initial
Last name
If filing a joint return, spouse’s first name
Initial
Last name
Present address (number and street or rural route)
Place “X” in box if you are
married filing separately.
City
State
Zip code + 4
Foreign Country (if applicable)
Enter loss year
Place “X” in box
if amendment
due to an NOL.
Are you filing an amended federal return? Yes No
If yes, attach a copy of your federal Form 1040X.
Enter the 2-digit county code numbers for the county where you lived and worked on January 1 of the tax year.
County where
County where
County where
County where
you lived
you worked
spouse lived
spouse worked
A
B
C
Attach a full explanation for filing this amended return. Attach all
As Shown on
Amount of
Correct
state and federal forms and schedules supporting these changes.
Original Return
Change
Amount
Part I - Income and Exemptions
1. Indiana adjusted income ..................................................
1
2. Total exemptions ..............................................................
2
Part II - Tax Due
3. State taxable income: line 1 minus line 2 ......................►
3
4. State adjusted gross income tax: line 3 x 3.4%(.034) ......
4
5. County income tax: complete Schedule CT-40 ................
5
6. Use tax due on out-of-state purchases ............................
6
7. Household employment tax: attach Schedule IN-H..........
7
8. Advance earned income credit payments from W-2(s) ....
8
9. Recapture of CollegeChoice 529 credit............................
9
10. Estimated tax applied to next year’s account . ..................
10
11. Penalty for underpayment of estimated tax . .....................
11
................................................................................. Total Tax 12
12. Total tax due: add lines 4 through 11
Part III - Credits
13. Indiana state tax withheld . ................................................
13
14. Indiana county tax withheld ..............................................
14
15. Amount of estimated tax paid . ..........................................
15
16. Other credits . ....................................................................
16
17. Amount paid on original return ..................................................................................................................... 17
18. Total credits: add lines 13 through 17........................................................................................................... 18
19. Amount previously refunded or requested before contribution to the nongame wildlife fund . ...................► 19
Net Credits
20. Net credits: line 18 minus line 19 ............................................................................................
20
*161091101*
DD
161091101
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