Amended Nebraska Individual Income Tax Return
FORM 1040XN
2010
Taxable Year of Original Return
beginning _________________, ______and ending ____________________ , ______
Your First Name and Initial
Last Name
PLEASE DO NOT WRITE IN THIS SPACE
If a Joint Return, Spouse’s First Name and Initial
Last Name
RESET
PRINT
Current Mailing Address (Number and Street or PO Box)
City, Town, or Post Office
State
Zip Code
Your Social Security Number
Spouse’s Social Security Number
(1)
Farmer/Rancher
(3)
Deceased Taxpayers (First Names and Dates of Death)
(2)
Active Military
Are you filing for a refund based on:
Are you filing this amended return because:
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 with supporting schedules, and a completed
Attach a copy of changes from the Internal Revenue Service .
Nebraska NOL Worksheet .
2
3
1
CHECK IF (on federal return):
Original Amended
TYPE OF RETURN 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
return
(3) Nonresident
(5) Widow(er) with dependent child(ren)
4 Federal exemptions (correct number of exemptions claimed on your federal return) . . . . . . . . . . . . . . . . . . . . . . 4
Correct Amount
Computation of Tax
5 Federal adjusted gross income (AGI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
6 Nebraska standard deduction (see Form 1040N instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Total itemized deductions (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8 State and local income tax included in line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9 Nebraska itemized deductions (line 7 minus line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
10 Amount from line 6 or line 9, whichever is greater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
11 Nebraska income before adjustments (line 5 minus line 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
12 Adjustments increasing federal AGI (from line 47 of Nebraska Schedule I) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
13 Adjustments decreasing federal AGI (from line 57 of Nebraska Schedule I) . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
14 Nebraska Tax Table income (line 11 plus line 12 minus line 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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15 Nebraska income tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
16 Nebraska minimum or other tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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17 Total Nebraska income tax (line 15 plus line 16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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COMPLETE PAGE 2
, (800) 742-7474 (NE and IA), (402) 471-5729
8-681-2010