Form 1040x - Amended U.s. Individual Income Tax Return
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21040X
Department of the Treasury—Internal Revenue Service
Amended U.S. Individual Income Tax Return
OMB No. 1545-0074
(Rev. December 2012)
Information about Form 1040X and its separate instructions is at
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This return is for calendar year
2012
2011
2010
2009
Other year. Enter one: calendar year
or fiscal year (month and year ended):
Your social security number
Your first name and initial
Last name
Spouse’s social security number
If a joint return, spouse’s first name and initial
Last name
Home address (number and street). If you have a P.O. box, see instructions.
Apt. no.
Your phone number
City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
Foreign postal code
Foreign country name
Foreign province/state/county
Amended return filing status. You must check one box even if you are not changing your filing status.
Caution. In general, you cannot change your filing status from joint to separate returns after the due date.
Single
Married filing jointly
Married filing separately
Head of household (If the qualifying person is a child but not your dependent, see instructions.)
Qualifying widow(er)
A. Original amount
B. Net change—
Use Part III on the back to explain any changes
or as previously
amount of increase
C. Correct
adjusted
or (decrease)—
amount
Income and Deductions
(see instructions)
explain in Part III
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Adjusted gross income. If net operating loss (NOL) carryback is
included, check here .
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Itemized deductions or standard deduction
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Subtract line 2 from line 1
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Exemptions. If changing, complete Part I on page 2 and enter the
amount from line 30 .
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Taxable income. Subtract line 4 from line 3 .
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Tax Liability
Tax. Enter method used to figure tax:
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Credits. If general business credit carryback is included, check
here .
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Subtract line 7 from line 6. If the result is zero or less, enter -0- .
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Other taxes .
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Total tax. Add lines 8 and 9 .
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Payments
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Federal income tax withheld and excess social security and tier 1 RRTA
tax withheld (if changing, see instructions) .
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Estimated tax payments, including amount applied from prior year’s
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return .
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Earned income credit (EIC) .
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Refundable credits from Schedule(s)
8812 or
M or Form(s)
2439
4136
5405
8801
8812 (2009–2011)
8839
8863
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8885 or
other (specify):
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Total amount paid with request for extension of time to file, tax paid with original return, and additional
tax paid after return was filed
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Total payments. Add lines 11 through 15
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Refund or Amount You Owe (
Note. Allow 8–12 weeks to process Form 1040X.)
Overpayment, if any, as shown on original return or as previously adjusted by the IRS .
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Subtract line 17 from line 16 (If less than zero, see instructions) .
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Amount you owe. If line 10, column C, is more than line 18, enter the difference
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If line 10, column C, is less than line 18, enter the difference. This is the amount overpaid on this return
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Amount of line 20 you want refunded to you .
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Amount of line 20 you want applied to your
(enter year):
estimated tax .
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Complete and sign this form on Page 2.
1040X
For Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 12-2012)
Cat. No. 11360L
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