Form Mi-1040x - Amended Michigan Income Tax Return Page 2
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2MI-1040X, Page 2
Check a box and/or enter a number for all that apply (see instructions).
EXEMPTIONS.
42.
Exemptions claimed on your original return.
43.
Exemptions claimed on this return.
Number of Federal exemptions
Number of Federal exemptions
Age 65 or older
Age 65 or older
Deaf
Deaf
Blind or disabled*
Blind or disabled*
Unemployment compensation
Unemployment compensation
(must be 50% of AGI.)
(must be 50% of AGI.)
For tax year 1999, number of
For tax year 1999, number of
children claimed as an exemption
children claimed as an exemption
Ages 6 and under
$600
Ages 6 and under
$600
Ages 7 - 12
$300
Ages 7 - 12
$300
For tax years beginning with 2000
For tax years beginning with 2000
$600
$600
number of children 18 and under
number of children 18 and under
*applies to people who are hemiplegic, paraplegic, quadriplegic or classified as totally and permanently disabled under Social Security guidelines.
44. List all your dependents and answer all questions for each dependent (E-H answer "Yes" or "No"). Attach separate sheet if necessary.
A
B
C
D
E
F
G
H
Did the dependent
Did you provide
Did the dependent
Was this
file a federal return
more than half the
live with you more
dependent
and claim exemption
dependent's
than 6 months
claimed on your
Name
Social Security Number
Relationship
Age
for self?
support?
during the year?
original return?
EXPLANATIONS OF CHANGES
45.
Explain change in number of dependents.
46.
Explain changes to income, deductions and credits. Show computations in detail and attach applicable schedules.
I declare under penalty of perjury that this return is based on all
I declare under penalty of perjury that the information in this return and attachments is true and
information of which I have any knowledge.
complete to the best of my knowledge.
4
Preparer's SSN, PTIN or FEIN
4I authorize Treasury to discuss my return with my preparer.
Yes
No
Filer's Signature
Date
4
Preparer's Name and Address
Spouse's Signature
Date
Make checks payable to "State of
Pay amount on line 40. Mail your check and return to:
Refund or Credit returns. Mail your return to:
Michigan." Print your Social Security
number,
the
tax
year
you
are
Michigan Department of Treasury
Michigan Department of Treasury
amending, and the words "amended
Lansing, MI 48956
Lansing, MI 48929
income tax" on the front of your check.
Do not staple your check to the return.
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