Form 1040x - Amended U.s. Individual Income Tax Return
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1
21040X
Department of the Treasury—Internal Revenue Service
OMB No. 1545-0074
Amended U.S. Individual Income Tax Return
See separate instructions.
(Rev. February 2007)
This return is for calendar year
, or fiscal year ended
,
.
Your first name and initial
Last name
Your social security number
Spouse’s social security number
If a joint return, spouse’s first name and initial
Last name
Home address (no. and street) or P.O. box if mail is not delivered to your home
Apt. no.
Phone number
(
)
City, town or post office, state, and ZIP code. If you have a foreign address, see page 3 of the instructions.
A
If the address shown above is different from that shown on your last return filed with the IRS, would you like us to change it
in our records?
Yes
No
B Filing status. Be sure to complete this line. Note. You cannot change from joint to separate returns after the due date.
On original return
Single
Married filing jointly
Married filing separately
Head of household
Qualifying widow(er)
*
On this return
Single
Married filing jointly
Married filing separately
Head of household
Qualifying widow(er)
*
If the qualifying person is a child but not your dependent, see page 3 of the instructions.
B. Net change—
A. Original amount or
Use Part II on the back to explain any changes
amount of increase
C. Correct
as previously adjusted
or (decrease)—
amount
(see page 3)
explain in Part II
Income and Deductions (see instructions)
1
Adjusted gross income (see page 3)
1
2
Itemized deductions or standard deduction (see page 3)
2
3
Subtract line 2 from line 1
3
4
Exemptions. If changing, fill in Parts I and II on the back
4
(see page 4)
Taxable income. Subtract line 4 from line 3
5
5
6
Tax (see page 5). Method used in col. C
6
7
7
Credits (see page 5)
8
Subtract line 7 from line 6. Enter the result but not less than zero
8
9
9
Other taxes (see page 5)
10
Total tax. Add lines 8 and 9
10
Federal income tax withheld and excess social security and
11
11
tier 1 RRTA tax withheld. If changing, see page 5
12
Estimated tax payments, including amount applied from prior
12
year’s return
13
13
Earned income credit (EIC)
14
14
Additional child tax credit from Form 8812
15
Credits: Federal telephone excise tax or from Forms 2439,
15
4136, or 8885
16
Amount paid with request for extension of time to file (see page 5)
16
17
17
Amount of tax paid with original return plus additional tax paid after it was filed
18
Total payments. Add lines 11 through 17 in column C
18
Refund or Amount You Owe
19
Overpayment, if any, as shown on original return or as previously adjusted by the IRS
19
20
Subtract line 19 from line 18 (see page 6)
20
21
Amount you owe. If line 10, column C, is more than line 20, enter the difference and see page 6
21
22
If line 10, column C, is less than line 20, enter the difference
22
23
23
Amount of line 22 you want refunded to you
24
Amount of line 22 you want applied to your
estimated tax
24
Under penalties of perjury, I declare that I have filed an original return and that I have examined this amended return, including accompanying schedules
Sign
and statements, and to the best of my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer (other than
Here
taxpayer) is based on all information of which the preparer has any knowledge.
Joint return?
See page 2.
Keep a copy for
Your signature
Date
Spouse’s signature. If a joint return, both must sign.
Date
your records.
Date
Preparer’s SSN or PTIN
Preparer’s
Check if
Paid
signature
self-employed
Preparer’s
Firm’s name (or
EIN
Use Only
yours if self-employed),
address, and ZIP code
Phone no. (
)
1040X
For Paperwork Reduction Act Notice, see page 6 of instructions.
Cat. No. 11360L
Form
(Rev. 2-2007)
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