Form 1040xn - Amended Nebraska Individual Income Tax Return 2009 Page 2
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3FORM 1040XN
Page 2
2009
(A) As Reported or Adjusted
(B) Net Change
(C) Correct Amount
Computation of Tax
18 Amount from line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
18
19 Nebraska personal exemption credit ($118 x the number
of exemptions on line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
19
20 Credit for tax paid to another state . . . . . . . . . . . . . . . . . . . 20
20
21 Credit for the elderly or the disabled . . . . . . . . . . . . . . . . . . 21
21
22 CDAA credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
22
23 Form 3800N nonrefundable credit . . . . . . . . . . . . . . . . . . . . 23
23
24 Nebraska child/dependent care credit . . . . . . . . . . . . . . . . 24
24
25 Nebraska Endowment credit . . . . . . . . . . . . . . . . . . . . . . . . 25
25
26 Credit for financial institution tax . . . . . . . . . . . . . . . . . . . . . 26
26
27 Total nonrefundable credits (total of lines 19 through 26) . . 27
27
28 Nebraska tax after nonrefundable credits . Line 18 minus
line 27 (if less than zero, enter -0-) (see instructions) . . . . . 28
28
29 Nebraska income tax withheld . . . . . . . . . . . . . . . . . . . . . . 29
29
30 Estimated tax payments . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
30
31 Form 3800N refundable credit . . . . . . . . . . . . . . . . . . . . . . . 31
31
32 Nebraska child/dependent care refundable credit . . . . . . . . 32
32
33 Beginning Farmer credit . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
33
34 Nebraska earned income credit . Number of qualifying
children
Federal credit
x .10
97
98
(10%) . Partial-year residents complete lines 74 and 75 . . . 34
34
35 Amount paid with original return, plus additional tax payments made after it was filed . . . . . . . . . . . . . . . . . . . 35
36 Total payments (total of lines 29 through 35, column C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
37 Overpayment allowed on original return, plus additional overpayments of tax allowed after it was filed . . . . . . 37
38 Line 36 minus line 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
39 Penalty for underpayment of estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
40 Total tax and penalty for underpayment of estimated tax. (total of line 28 plus line 39) . . . . . . . . . . . . . . . . 40
41 TOTAL AMOUNT DUE. If line 38, column C is less than line 40, subtract line 38 from line 40, column C
and enter result . Otherwise, skip to line 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
42 Penalty (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
43 Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
44 Total BALANCE DUE (total of lines 41 through 43) . Pay in full with this return . . . . . . . . . . . . . . . . . . . . . . . . . . 44
45 REFUND to be received (If line 38 is more than line 40, subtract line 40 from line 38) (Allow three months
for your refund) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Explanation of Changes
• Attach additional sheets or schedules if necessary.
• Reference net change (Column B) and line number.
Expecting a Refund? Have it sent directly to your bank account!
46a Routing Number
46b Type of Account
1 = Checking
2 = Savings
(Enter 9 digits, first two digits must be 01 through 12, or 21 through 32;
use an actual check or savings account number, not a deposit slip)
46c Account Number
(Can be up to 17 characters . Omit hyphens, spaces, and special symbols . Enter from left to right and leave any unused boxes blank .)
46d
Check this box if this refund will go to a bank account outside the United States .
Under penalties of perjury, I declare that, as taxpayer or preparer, I have examined this return and to the best of my knowledge and belief, it is correct and complete .
sign
here
Your Signature
Date
E-Mail Address
(
)
Spouse’s Signature (if filing jointly, both must sign)
Daytime Phone
paid
preparer’s
Preparer’s Signature
Date
Preparer’s Social Security Number or PTIN
use only
(
)
Print Firm’s Name (or yours if self-employed), Address and Zip Code
EIN
Daytime Phone
Mail this return and payment to: NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 98911, LINCOLN, NE 68509-8911
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