Form 40x Draft - Oregon Amended Individual Income Tax Return Page 2

Form 40X

Page 2 —

Explanation of adjustments made —Show the computations in detail. Attach applicable schedules.

I authorize the Department of

Under penalties for false swearing, I declare that I have examined this return, including accompanying schedules

Revenue to discuss this return

and statements. To the best of my knowledge and belief it is true, correct, and complete. If prepared by a person

with this preparer.

Yes

other than the taxpayer, this declaration is based on all information of which the preparer has any knowledge.

Your signature

Date

Signature of preparer other than taxpayer

License No.

SIGN

Spouse’s signature

Date

Telephone No.

(If filing jointly, BOTH must sign)

HERE

Address

150-101-046 (Rev. 12-02)

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Parent category: Financial