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

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Form 40X

Page 2 —

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

Under penalties for false swearing, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and

belief it is true, correct and complete. If prepared by a person other than taxpayer, this declaration is based on all information of which the preparer has any knowledge.

SIGN

Your signature

Date

Signature of preparer other than taxpayer

License No.

HERE

Address

Spouse’s signature (If filing jointly, BOTH must sign even if only one had income)

150-101-046 (Rev. 9-98) (back)