Form It-201-X - Amended Resident Income Tax Return - 2014 Page 6
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6Page 6 of 6 IT-201-X (2014)
Your social security number
83 Reason(s) for amending your return
(mark an X in all applicable boxes; see instructions)
83a Federal audit change
83b Worthless stock/securities ..............
) ................................................
(complete lines 84 through 91 below
83c Claim of right ...............................
83d Wages ...........................................
83e Military .............................................
83f Court ruling ..................................
83g Workers’ compensation ..................
83h Treaties/visa ....................................
83i Tax shelter transaction ................
83j Credit claim .....................................
83k Protective claim
......
(see instructions)
83l Net operating loss
. Mark an X in the box ....
and enter the year of the loss ....
(see instructions)
83m Other. Mark an X in the box ...
and explain:
83n To report adjustments to partnership or S corporation income, gain, loss or deduction, provide the following information:
Partnership
S corporation
Name of partnership or S corporation
Identifying number
Principal business activity
Address of partnership or S corporation
If you marked an X in box 83a above, you must complete lines 84 through 91 below. All others may skip lines 84
through 91 and go directly to the Third-party designee question. You must sign your amended return below.
84 Enter the date
85 Do you concede the federal audit
of the
(mmddyyyy)
final federal determination
changes?
....... Yes
No
(If No, explain below.)
(Explain)
86 List federal changes
86a
86a
00
86b
86b
00
86c
86c
00
86d
86d
00
86e
86e
00
87 Net federal changes (increase or decrease) ...........................................................................
87
00
88 Federal taxable income
Per return
Previously adjusted
....
88
(mark an X in one box)
00
89 Corrected federal taxable income ............................................................................................
89
00
90 Federal credits disallowed ........
Earned income credit
Amount disallowed
Child care credit
Amount disallowed
91 Federal penalties assessed
Fraud .............................................
91a
91b Negligence ........................
91c Other
..........................
(explain below)
Print designee’s name
Designee’s phone number
Personal identification
Third-party
number (PIN)
(
)
designee?
E-mail:
Yes
No
Date
Taxpayer(s) must sign here
Paid preparer must complete
(see instr.)
Preparer’s signature
Preparer’s NYTPRIN
Your signature
Firm’s name (or yours, if self-employed)
Preparer’s PTIN or SSN
Your occupation
Address
Employer identification number
Spouse’s signature and occupation (if joint return)
NYTPRIN
Date
Daytime phone number
(
)
excl. code
E-mail:
E-mail:
See instructions for where to mail your return.
361006140094
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