Form It-203-X - New York Amended Nonresident And Part-Year Resident - 2012 Page 6

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Page 6 of 6 IT-203-X (2012)
Enter your social security number
75 Reason(s) for amending your return
(mark an X in all applicable boxes; see instructions)
75a Federal audit change
75b Military ............................................
) .................................................
(complete lines 76 through 83 below
75c Court ruling ....................................
75d Treaties/visa ...................................
75e Tax shelter transaction ....................
75f Wages allocation ...........................
75g Worthless stock/securities ..............
75h Workers’ compensation .................
75i Claim of right .................................
75j Credit claim ....................................
75k Protective claim
....
(see instructions)
75l Net operating loss
. Mark an X in the box .....
and enter the year of the loss ....
(see instructions)
75m Other. Mark an X in the box ...
and explain:
75n 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 75a above, you must complete lines 76 through 83 below. All others may skip lines 76
through 83 and go directly to the Third-party designee question. You must sign your amended return below.
76 Enter the date
77 Do you concede the federal audit
of the
(mm-dd-yyyy)
final federal determination ....
changes?
........Yes
No
(If No, explain below.)
(Explain)
78 List federal changes
Whole dollars only
.
78a
78a
00
.
78b
78b
00
.
78c
78c
00
.
78d
78d
00
.
78e
78e
00
.
79 Net federal changes (increase or decrease) ...........................................................................
79
00
.
80 Federal taxable income
80
Per return
Previously adjusted
.......
(mark an X in one box)
00
.
81 Corrected federal taxable income ...........................................................................................
81
00
82 Federal credits disallowed ........
Earned income credit
Amount disallowed
Child care credit
Amount disallowed
83 Federal penalties assessed
83a Fraud .............................................
83b Negligence ........................
83c Other
..........................
(explain below)
Print designee’s name
Designee’s phone number
Personal identification
Third-party
number (PIN)
designee?
(see instr.)
(
)
E-mail:
Yes
No
  Taxpayer(s) must sign here
Date
  Paid preparer must complete
(see instr.)
Your signature
Preparer’s signature
Preparer’s NYTPRIN
Your occupation
Firm’s name (or yours, if self-employed)
Preparer’s PTIN or SSN
Employer identification number
Spouse’s signature and occupation (if joint return)
Address
Daytime phone number
Date
Mark an X if
(
)
self-employed
E-mail:
E-mail:
See instructions for where to mail your return.
363006120094

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