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Form 1040X (Rev. 12-2013)
Page
Part I
Exemptions
Complete this part only if you are increasing or decreasing the number of exemptions (personal and dependents) claimed on line 6d of
the return you are amending.
A. Original number
of exemptions or
C. Correct
See Form 1040 or Form 1040A instructions and Form 1040X instructions.
amount reported or
B. Net change
number
as previously
or amount
adjusted
23
Yourself and spouse. Caution. If someone can claim you as a
23
dependent, you cannot claim an exemption for yourself .
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24
24
Your dependent children who lived with you
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25
Your dependent children who did not live with you due to divorce or separation
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26
Other dependents .
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26
27
Total number of exemptions. Add lines 23 through 26 .
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27
28
Multiply the number of exemptions claimed on line 27 by the exemption
amount shown in the instructions for line 28 for the year you are
amending. Enter the result here and on line 4 on page 1 of this form .
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28
29
List ALL dependents (children and others) claimed on this amended return. If more than 4 dependents, see instructions.
(d) Check box if qualifying
(b) Dependent’s social
c) Dependent’s
(
(a) First name
Last name
child for child tax credit (see
security number
relationship to you
instructions)
Part II
Presidential Election Campaign Fund
Checking below will not increase your tax or reduce your refund.
Check here if you did not previously want $3 to go to the fund, but now do.
Check here if this is a joint return and your spouse did not previously want $3 to go to the fund, but now does.
Part III
Explanation of changes. In the space provided below, tell us why you are filing Form 1040X.
Attach any supporting documents and new or changed forms and schedules.
▶
Sign Here
Remember to keep a copy of this form for your records.
Under penalties of perjury, I declare that I have filed an original return and that I have examined this amended return, including accompanying
schedules and statements, and to the best of my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer
(other than taxpayer) is based on all information about which the preparer has any knowledge.
Your signature
Date
Spouse’s signature. If a joint return, both must sign.
Date
Paid Preparer Use Only
Preparer’s signature
Date
Firm’s name (or yours if self-employed)
Print/type preparer's name
Firm's address and ZIP code
Check if self-employed
PTIN
Phone number
EIN
1040X
For forms and publications, visit IRS.gov.
Form
(Rev. 12-2013)