Form Ri-1040x - Amended Rhode Island Individual Income Tax Return - 2004
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2RI-1040X
2004
Amended Rhode Island Individual Income Tax Return
(To be used by resident, nonresident and part-year resident taxpayers)
Name and
First Name
Initial
Last Name
Your Social Security Number
Address
Initial
Last Name
Spouse’s Social Security Number
Spouse’s First Name
Present Home Address (number and street, including apartment no. or rural route)
Daytime Telephone Number
Please
(
)
print or type
City or Town of Legal Residence
City, Town or Post Office
State
Zip Code
A.
Enter name and address used on original return (if same as above write “SAME”)
Additional
Information
B.
Are you filing an amended federal income tax return? ...................................................................................
Yes
No
Have you been advised your federal return is under examination? ...............................................................
C.
Yes
No
Filing
D.
On original return
Status
1. Single
2. Married filing jointly
3. Married filing separately
4. Head of Household
5. Qualifying widow(er)
E.
On this return
1. Single
2. Married filing jointly
3. Married filing separately
4. Head of Household
5. Qualifying widow(er)
Income
A. Originally reported
B. Net change
C. Correct amount
1.
Federal AGI (Adjusted Gross Income) ...........................................
1.
2.
2.
Modifications from RI-1040(NR), page 2, Schedule I, Line 25 ......
3.
3.
Modified Federal AGI - Combine lines 1 and 2 .............................
4.
Deductions
(see
instructions).........................................................
4.
5.
Subtract line 4 from line 3 ..............................................................
5.
6.
Exemptions - Enter the number of federal exemptions
claimed on this return in the box then multiply by
6.
$3,100 and enter the result on line 6, column C.
7.
RI Taxable Income - subtract line 6 from line 5..............................
7.
8A.
RI income tax .................................................................................
8A.
Tax
Check method used on line 8A, column C
RI Tax Table or
RI Schedule CGW
RI Schedule D
RI Schedule J
RI-8615
Rate Schedule
8B.
Other RI Taxes from RI-1040(NR), page 3, line 14........................
8B.
9.
RI Alternative Minimum Tax from RI-6251, line 14 ........................
9.
10.
Total RI income tax - add lines 8A, 8B and 9 ................................
10.
Nonresidents - Enter the amount from page 1, line 10
Form Type
Residents - Enter the amount from page 1, line 10 on
page 2, part 2, line 10 and complete page 2, part 2.
on page 2, part 3, line 10 and complete page 2, part 3.
17.
17.
Payments
Total RI Tax and checkoff contributions .........................................
18. A. RI 2004 income tax withheld ..................................................
18A.
B.
2004 estimated tax payments and 2003 carryforward ...........
18B.
18C.
C.
Property tax relief credit from RI-1040H (residents only)......
D.
Nonresident real estate withholding (nonresidents only)......
18D.
E.
Withholding from pass-through entities (nonresidents only).
18E.
F.
RI Earned Income Credit.........................................................
18F.
G.
Other Payments .............................................................................................................................................
18G.
H.
Total - Add lines 18A, 18B, 18C, 18D, 18E, 18F and 18G.............................................................................
18H.
I.
Overpayment allowed on original return ........................................................................................................
18I.
J.
Total payments after overpayment - subtract line 18I from 18H.....................................................................
18J.
19. A. If line 17 is larger than 18J, subtract line 18J from 17. This is the amount you owe.........................
19A.
Amount
B.
Interest due on amount on line 19A ....................................................................................................
19B.
Due
C.
Total balance due - add lines 19A and 19B ........................................................................................
19C.
Refund
20. If line 18J is larger than line 17, subtract line 17 from 18J. This is the amount you overpaid...................
20.
☺
21.
Amount of overpayment to be refunded .....................................................................................................
21.
22.
Amount of overpayment to be applied to 2005 estimated tax ..................................
22.
RETURN MUST BE SIGNED - SIGNATURE LINE IS LOCATED ON PAGE 2
Mail returns to - RI Division of Taxation One Capitol Hill Providence, RI 02908-5806
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