Form 40x - Oregon Amended Individual Income Tax Return
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1
2FORM
OREGON AMENDED
40X
For Office Use Only
INDIVIDUAL INCOME
Original Return Number
Date Received
TAX RETURN
Code
Tax
P&I
Payment Amount
Check if amending to change from
FOR TAX YEAR _____________
married filing separate to filing joint.
Last name
First name and initial
Social Security number (SSN)
Birth year
—
—
Spouse’s last name, if different and joint return
Spouse’s first name and initial, if joint return
Spouse’s SSN if joint return
Spouse’s
birth year
—
—
Current mailing address
City
State
ZIP code
Telephone number
(
)
A.
As originally
B.
Net change
C.
INCOME AND DEDUCTIONS
reported or
(increase or
as adjusted
Correct
decrease–explain
(Please read instructions)
amount
(see specific instr.)
on the back)
1. Income
1
2. Additions
2
3. Federal tax liability (Form 40S only)
3
4. Subtractions
4
5. Deductions (standard deduction or itemized deductions)
5
6. Oregon taxable income
6
TAX AND CREDITS
7. TAX
7
8. Interest on certain installment sales
8
9. TOTAL OREGON TAX (add lines 7 and 8)
9
10. Exemption credit (see instructions)
10
11. Other income tax credits
11
12. Total credits (add lines 10 and 11) (it can’t be more than amount on line 9)
12
13. Net income tax (line 9 minus line 12)
13
PAYMENTS
14. State surplus “kicker” refund—if applicable (see instructions)
14
15. Oregon income tax withheld
15
16. Estimated tax payment(s) for the tax year and payments made with extension requests
16
17. Amount paid with original return and any later payment(s) for the tax year (include TAX paid only—see instructions)
17
18. Total payments (add lines 14 through 17)
18
(
)
19. Less income tax refunds
19
20. Net payments (line 18 minus line 19)
20
REFUND OR BALANCE DUE
21. Refund. If line 20 is more than line 13C, you overpaid. Line 20 minus line 13C
21
22. Amount of line 21 you want applied to your 200__ estimated tax
22
23. NET REFUND. Line 21 minus line 22. Enter the amount of line 21 you want refunded to you
23
24. Additional tax-to-pay. If line 13C is more than line 20, you have tax-to-pay. Line 13C minus line 20
24
25. Interest on additional tax-to-pay (see instructions)
25
26. AMOUNT-YOU-OWE. Add lines 24 and 25. Pay in full with this return
26
Attach a copy of your federal Form 1040X if you also amended your federal return.
See instructions for additional items to attach.
Mail refund returns and no tax due returns to:
Mail tax-to-pay returns to:
Refund, PO Box 14700, Salem OR 97309-0930
Oregon Department of Revenue, PO Box 14555, Salem OR 97309-0940
Refunds may take three to four months to process.
150-101-046 (Rev. 9-00) Web
Be sure to complete the back and sign
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