Form 1040xn - Amended Nebraska Individual Income Tax Return

(A) As Reported or Adjusted

(B) Net Change

Computation of Tax

18 Amount from line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

19 Nebraska personal exemption credit . . . . . . . . . . . . . . . . . . 19

20 Credit for tax paid to another state . . . . . . . . . . . . . . . . . . . 20

21 Credit for the elderly or the disabled . . . . . . . . . . . . . . . . . . 21

22 CDAA credit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

23 Form 3800N nonrefundable credit. . . . . . . . . . . . . . . . . . . . 23

24 Credit for child and dependent care expenses . . . . . . . . . . 24

25 Nebraska Charitable Endowment Tax credit . . . . . . . . . . . . 25

26 Credit for ﬁnancial institution tax . . . . . . . . . . . . . . . . . . . . . 26

27 Total nonrefundable credits (total of lines 19 through 26) . . 27

28 Line 18 minus line 27 (if less than zero, enter -0-)

(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

29 Nebraska income tax withheld . . . . . . . . . . . . . . . . . . . . . . 29

30 Estimated tax payments . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

31 Form 3800N refundable credit. . . . . . . . . . . . . . . . . . . . . . . 31

32 Refundable credit for child/dependent care expenses . . . . 32

33 Beginning Farmer credit . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

34 Nebraska earned income credit. Number of qualifying

children

Federal credit

x .10

(10%). Partial-year residents complete lines 73 and 74 . . . 34

35 Amount paid with original return, plus additional tax payments made after it was ﬁled . . . . . . . . . . . . . . . . . . . 35

36 Total payments (total of lines 29 through 35, column C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

37 Overpayment allowed on original return, plus additional overpayments of tax allowed after it was ﬁled . . . . . . 37

38 Line 36 minus line 37 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

39 Penalty for underpayment of estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

40 Total tax and penalty for underpayment of estimated tax. (Total line 28 plus line 39) . . . . . . . . . . . . . . . . . 40

41 TOTAL AMOUNT DUE. If line 38, column C is less than line 40, subtract line 38 from line 40, column C

and enter result. Otherwise, skip to line 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

42 Penalty (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

43 Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

44 Total BALANCE DUE (total of lines 41 through 43). Pay in full with this return . . . . . . . . . . . . . . . . . . . . . . . . . . 44

45 REFUND to be received (If line 38 is more than line 40 subtract line 40 from line 38) (Allow three months

for your refund) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Explanation of Changes

• Attach additional sheets or schedules if necessary

• Reference net change (Column B) and line number

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

is correct and complete.

sign

Your Signature

Date

Signature of Preparer Other than Taxpayer

Date

here

Spouse's Signature (if ﬁling jointly both must sign)

Daytime Phone

Preparer’s Address

Daytime Phone

Mail this return and payment to: NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 98911, LINCOLN, NE 68509-8911