Form Pit-X - Amended New Mexico Personal Income Tax Form Page 2

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YOUR SOCIAL SECURITY NUMBER

PIT-X

9 7 1 0 0 3 0 2

AMENDED

AMENDED NEW MEXICO PERSONAL INCOME TAX FORM

AMOUNT

16.Overpayment, if any, shown on original return or as adjusted by Department .........................................................

17.Voluntary fund contributions from original return. ......................................................................................................

18.Net overpayment (SUBTRACT line 17 from line 16) .................................................................................................

19.SUBTRACT line 16 from line 15. ...............................................................................................................................

20.Additional tax due. If line 8, Column C, is more than line 19, enter the difference. ..................................................

21.Interest on tax due .....................................................................................................................................................

22.Penalty on tax due .....................................................................................................................................................

23.Total Due. (ADD lines 20, 21 and 22) ........................................................................................................................

24.If line 8, Column C, is less than line 19, enter the difference. ...................................................................................

25.Amount of line 24 you want refunded to you. ............................................................................................................

26.Amount of line 24 you want applied to your 19 _______ estimated tax ...................................................................

PART I - EXEMPTIONS / DEPENDENTS

If you are not changing your exemptions or dependents, DO NOT complete this part.

NUMBER

NET CHANGE

ORIGINALLY

AMENDED

INCREASE

REPORTED

NUMBER

If claiming MORE exemptions or dependents, complete lines 27-33.

(DECREASE)

If claiming FEWER exemptions or dependents, complete lines 27-32.

27. Yourself and spouse ..............................................................................................................

28. Yourself

over 65

blind .....................................................................................

29. Your spouse

over 65

blind .............................................................................

30. Number of dependents for federal income tax purposes claimed on PIT-1 or PIT-A .............

31. Additional qualifying dependents for rebate & credit purposes claimed on PIT-A or PIT-1-RC

32. Total exemptions and dependents (ADD lines 27-31) ............................................................

33. DEPENDENTS NOT CLAIMED ON ORIGINAL RETURN

a. First Name

Last Name

b. Age

c. Dependents Social

d. Dependents

e. Number of

Security or individual

relationship

months lived

taxpayer identification

to you

in your home

number

PART II - EXPLANATION OF ALL CHANGES

Enter the line number for each item you are changing (lines 1-12 on page 1 and lines 27-32 on page 2) and give the reason for each change. Attach supporting

federal or New Mexico forms and schedules, if any, for the items changed. Be sure to include your name and social security number on any attachments or

continuation sheets.

NOTE: If you do not attach the required information, or do not provide adequate documentation for your changes, your PIT-X may be returned to you.