Form It-40x Draft (State Form 44405) - Indiana Amended Individual Income Tax Return

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Indiana Amended Individual Income Tax Return
Form
Tax
IT-40X
Year
If you are not fi ling for the calendar year January 1 through December 31, enter period from:
State Form 44405
(R8 / 9-09)
/
/
/
/
to:
Your Social
Spouse’s Social
Security Number
Security Number
Your fi rst name
Initial
Last name
If fi ling a joint return, spouse’s fi rst name
Initial
Last name
Present address (number and street or rural route)
Place “X” in box if you are
married fi ling separately.
City
State
Zip code + 4
Foreign Country (if applicable)
Enter loss year
Place “X” in box
if amendment
due to an NOL.
Are you fi ling an amended federal return?
Yes
No
If yes, attach a copy of your federal Form 1040X.
Enter the 2-digit county code numbers for the county where you lived and worked on January 1 of the tax year.
County where
County where
County where
County where
you lived
you worked
spouse lived
spouse worked
A
B
C
Attach a full explanation for fi ling this amended return. Attach all
As Shown on
Amount of
Correct
state and federal forms and schedules supporting these changes.
Original Return
Change
Amount
Part I - Income and Exemptions
1.
Indiana adjusted income ..................................................
1
2.
Total exemptions ..............................................................
2
Part II - Tax Due
3.
State taxable income: line 1 minus line 2 ......................►
3
4.
State adjusted gross income tax: line 3 x 3.4%(.034) ......
4
5.
County income tax: complete Schedule CT-40 ................
5
6.
Use tax due on out-of-state purchases ............................
6
7.
Household employment tax: attach Schedule IN-H..........
7
8.
Advance earned income credit payments from W-2(s) ....
8
9.
Recapture of CollegeChoice 529 credit............................
9
10.
Estimated tax applied to next year’s account ...................
10
11.
Penalty for underpayment of estimated tax ......................
11
................................................................................. Total Tax 12
12.
Total tax due: add lines 4 through 11
Part III - Credits
13.
Indiana state tax withheld .................................................
13
14.
Indiana county tax withheld ..............................................
14
15.
Amount of estimated tax paid ...........................................
15
16.
Other credits .....................................................................
16
17.
Amount paid on original return ..................................................................................................................... 17
18.
Total credits: add lines 13 through 17........................................................................................................... 18
19.
Amount previously refunded or requested before contribution to the nongame wildlife fund ....................► 19
Net Credits
20.
Net credits: line 18 minus line 19 ............................................................................................
20

DD
161091101

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