Form It-40x - Indiana Amended Individual Income Tax Return
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1
2Form
Indiana Amended Individual Income Tax Return
IT-40X
Year
State Form 44405
R4 / 8-05
If you are not filing for the calendar year January 1 through December 31, enter period from:
to:
Your first name
Initial Last name
Social Security Number
If filing a joint return, spouse’s first name
Initial
Last name
Social Security Number
Present address (number and street or rural route)
Foreign Country
(if applicable)
City
State
Zip Code + 4
Check box if amendment Enter loss
due to an NOL ...........
Year ______
Enter the 2-digit county code numbers for the county where you lived and worked on January 1,
(see instructions).
County where
County where
County where
County where
Yourself:
Spouse:
you lived
you worked
you lived
you worked
Attach a full explanation for filing amended return. Attach all
A
B
C
state and federal forms and schedules supporting these changes.
As Shown on
Correct
Amount of
Part I - Income and Exemptions
Original Return
Amount
Change
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. Estimated tax applied to next year’s account ..................
9
10. Penalty for underpayment of estimated tax .....................
10
............................................................................ Total Tax
11. Total tax due: add lines 4 through 10
11
Part III - Credits
12. Indiana state tax withheld ................................................
12
13. Indiana county tax withheld ..............................................
13
14. Amount of estimated tax paid ..........................................
14
15. Other credits .....................................................................
15
16. Amount paid on original return ..............................................................................................................
16
17. Total credits: add lines 12 through 16 ..................................................................................................
17
18. Amount previously refunded or requested before contribution to the nongame wildlife fund ..............
18
Net Credits
19. Net credits: line 17 minus line 18 .......................................................................................
19
Part IV - Refund or Amount Due
............................. Your Refund
20. Refund: If line 19 is greater than line 11, enter the difference here
20
21. Amount Due: If line 11 is greater than line 19, enter the difference here .............................................
21
22. Penalty (10% of line 21) .........................................................................................................................
22
23. Interest (see instructions for the rate) ...................................................................................................
23
Pay This Amount
24. Total Amount Due (
see instruction page for information on how to make your payment)
24
DD
Signatures are required on the following page
VN
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