Fillable Form 1045 - Application For Tentative Refund

1045

Application for Tentative Refund

OMB No. 1545-0098

Form

2013

Separate instructions and additional information are available at IRS.gov/form1045.

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Do not attach to your income tax return. Mail in a separate envelope.

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Department of the Treasury

Internal Revenue Service

For use by individuals, estates, or trusts.

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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, page 2)

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 2013, or other tax year

beginning

, 2013, and ending

, 20

If this application is for an unused credit created by another carryback, enter year of first carryback

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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

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If SSN for carryback year is different from above, enter a SSN

and b Year(s)

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If you changed your accounting period, give date permission to change was granted

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Have you filed a petition in Tax Court for the year(s) to which the carryback is to be applied?

Yes

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

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

Computation of Decrease in Tax

preceding

(see instructions)

tax year ended

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Before

After

Before

After

Before

After

Note: If 1a and 1c are blank, skip lines 10 through 15.

carryback

NOL deduction after carryback (see instructions)

Adjusted gross income

Deductions (see instructions)

Subtract line 12 from line 11

Exemptions (see instructions) .

Taxable income. Line 13 minus line 14

Income tax. See instructions and

attach an explanation .

Alternative minimum tax .

Add lines 16 and 17

General business credit (see instructions)

Other credits. Identify .

Total credits. Add lines 19 and 20 .

Subtract line 21 from line 18

Self-employment tax .

Other taxes .

Total tax. Add lines 22 through 24 .

Enter the amount from the “After

carryback” column on line 25 for each year

Decrease in tax. Line 25 minus line 26

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

Sign

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

Here

Your signature

Date

Keep a copy of

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

Date

this application

for your records.

Preparer’s signature

Date

PTIN

Print/Type preparer’s name

Check

Paid

self-employed

Preparer

Firm’s name

Firm's EIN

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Use Only

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Firm’s address

Phone no.

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1045

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.

Form

(2013)

Cat. No. 10670A

Form 1045 - Application For Tentative Refund - 2013

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