Form 1045 - Application For Tentative Refund - 2015
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51045
Application for Tentative Refund
OMB No. 1545-0098
Form
2015
Separate instructions and additional information are available at
▶
Do not attach to your income tax return. Mail in a separate envelope.
▶
Department of the Treasury
For use by individuals, estates, or trusts.
Internal Revenue Service
▶
Name(s) shown on return
Social security or employer identification number
Number, street, and apt. or suite no. If a P.O. box, see instructions.
Spouse’s social security number (SSN)
City, town or post office, state, and ZIP code. If a foreign address, also complete spaces below (see instructions).
Daytime phone number
Foreign country name
Foreign province/county
Foreign postal code
1 This application is filed
a Net operating loss (NOL) (Sch. A, line 25)
b Unused general business credit
c Net section 1256 contracts loss
to carry back:
$
$
$
2 a
b Date tax return was filed
For the calendar year 2015, or other tax year
beginning
, 2015, and ending
, 20
If this application is for an unused credit created by another carryback, enter year of first carryback
3
▶
4
If you filed a joint return (or separate return) for some, but not all, of the tax years involved in figuring the carryback, list the
years and specify whether joint (J) or separate (S) return for each
▶
If SSN for carryback year is different from above, enter a SSN
and b Year(s)
5
▶
▶
If you changed your accounting period, give date permission to change was granted
6
▶
7
Have you filed a petition in Tax Court for the year(s) to which the carryback is to be applied?
.
.
.
.
.
Yes
No
8
Is any part of the decrease in tax due to a loss or credit resulting from a reportable transaction required to be
disclosed on Form 8886, Reportable Transaction Disclosure Statement? .
.
.
.
.
.
.
.
.
.
.
.
Yes
No
9
If you are carrying back an NOL or net section 1256 contracts loss, did this cause the release of foreign tax
credits or the release of other credits due to the release of the foreign tax credit (see instructions)? .
.
.
Yes
No
Computation of Decrease in Tax
preceding
preceding
preceding
(see instructions)
tax year ended
tax year ended
tax year ended
▶
▶
▶
Before
After
Before
After
Before
After
Note: If 1a and 1c are blank, skip lines 10 through 15.
carryback
carryback
carryback
carryback
carryback
carryback
10
NOL deduction after carryback (see instructions)
11
Adjusted gross income
.
.
.
.
.
12
Deductions (see instructions)
.
.
.
13
Subtract line 12 from line 11
.
.
.
14
Exemptions (see instructions) .
.
.
15
Taxable income. Line 13 minus line 14
16
Income tax. See instructions and
attach an explanation .
.
.
.
.
.
17
Excess advance premium tax credit
repayment (see instructions) .
.
.
.
18
Alternative minimum tax .
.
.
.
.
19
Add lines 16 through 18
.
.
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.
1045
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
Form
(2015)
Cat. No. 10670A
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