Form 1040xn - Amended Nebraska Individual Income Tax Return 2009
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3Amended Nebraska Individual Income Tax Return
FORM 1040XN
2009
Taxable Year of Original Return
beginning _____________, ______and ending _______________ , ______
PLEASE DO NOT WRITE IN THIS SPACE
RESET
PRINT
Your First Name and Initial
Last Name
If a Joint Return, Spouse’s First Name and Initial
Last Name
Your Social Security Number
Spouse’s Social Security Number
Current Mailing Address (Number and Street or P .O . Box)
(1)
Farmer/Rancher
(2)
Active Military
(3)
Deceased Taxpayer(s) (First Name[s] and Date[s] of Death)
City, Town, or Post Office
State
Zip Code
Are you filing this amended return because:
Are you filing for a refund based on:
a . The Nebraska Department of Revenue has
YES
NO
a . The filing of a federal amended return or claim for refund?
YES
NO
notified you that your return will be audited?
Attach copies of Federal Form 1045 or 1040X and supporting schedules .
b . The Internal Revenue Service has corrected
YES
NO
b . Carryback of a net operating loss or IRC § 1256 loss?
YES
NO
your federal return?
If Yes, year of loss:
Amount: $
If Yes, identify office:
Attach copies of Federal Form 1045 or 1040X and supporting schedules, including
Attach a copy of changes from the Internal Revenue Service .
Nebraska NOL Worksheet .
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CHECK IF (on federal return):
Original Amended
TYPE OF RETURN BEING FILED
FEDERAL FILING STATUS (check only one for each return):
Original
Amended
(check only one for each return):
(1) You were 65 or over
Original
Amended
(1) Single
(2) You were blind
(1) Resident
(2) Married, filing jointly
(2) Partial-year
(3) Spouse was 65 or over
(3) Married, filing separately
resident
(4) Spouse was blind
Spouse’s SSN:
from _______
_______ ______
(5) You or your spouse can be claimed
(4) Head of household
to _________
_______ ______
as a dependent on another person’s
(5) Widow(er) with dependent child(ren)
return
(3) Nonresident
4 Federal exemptions (number of exemptions claimed on your federal return) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
(A) As Reported
(B) Net Change
(C) Correct Amount
Computation of Tax
or Adjusted
5 Federal adjusted gross income (AGI) . . . . . . . . . . . . . . . . .
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6 Nebraska standard deduction (see Form 1040N instructions) 6
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7 Total itemized deductions (see instructions) . . . . . . . . . . . .
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8 State and local income tax included in line 7 . . . . . . . . . . .
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9 Nebraska itemized deductions (line 7 minus line 8) . . . . . .
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10 Amount from line 6 or line 9, whichever is greater . . . . . . . 10
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11 Nebr . income before adjustments (line 5 minus line 10) . . . 11
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12 Adjustments increasing federal AGI . . . . . . . . . . . . . . . . . . 12
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13 Adjustments decreasing federal AGI . . . . . . . . . . . . . . . . . . 13
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14 Nebraska Tax Table income
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(line 11 plus line 12 minus line 13) . . . . . . . . . . . . . . . . . .
15 Nebraska income tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
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16 Nebraska minimum or other tax . . . . . . . . . . . . . . . . . . . . . 16
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17 Total Nebraska income tax (line 15 plus line 16) . . . . . . . . . 17
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NEBRASKA DEPARTMENT OF REVENUE USE ONLY:
Int . Type
Int . Calc . Date
Para . Code
COMPLETE REVERSE SIDE
, (800) 742-7474 (toll free in NE and IA), (402) 471-5729
8-667-2009
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