Fillable Form 1045 - Application For Tentative Refund

Form 1045 - Application For Tentative Refund - 2015 Page 2

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Form 1045 (2015)

Page

Computation of Decrease in Tax

preceding

(Continued)

tax year ended

▶

Before

After

Before

After

Before

After

carryback

General business credit (see instructions)

Net premium tax credit (see instructions)

Other credits. Identify .

Total credits. Add lines 20 through 22

Subtract line 23 from line 19 .

Self-employment tax (see instructions)

Additional medicare tax (see instructions)

Net

investment

income

tax

(see

instructions) .

Health care: individual responsibility

(see instructions)

Other taxes .

Total tax. Add lines 24 through 29 .

Enter the amount from the “After

carryback” column on line 30 for each year

Decrease in tax. Line 30 minus line 31

Overpayment of tax due to a claim of right adjustment under section 1341(b)(1) (attach computation)

Under penalties of perjury, I declare that I have examined this application and accompanying schedules and statements, and to the best of my knowledge

and belief, they are true, correct, and complete.

Sign

Your signature

Date

Here

Keep a copy of

this application

Spouse’s signature. If Form 1045 is filed jointly, both must sign.

Date

for your records.

Preparer’s signature

Date