Form Mi-1040x-12 - Michigan Amended Income Tax Return Page 2
Download a blank fillable Form Mi-1040x-12 - Michigan Amended Income Tax Return in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Mi-1040x-12 - Michigan Amended Income Tax Return with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4MI-1040X-12, Page 2 of 2
Filer’s Full Social Security Number
*Enter dates of Michigan residency for tax year being amended.
Enter dates as MM-DD-YYYY (Example: 04-15-2014).
Nonresident
Part-Year Resident *
RESIDENCY STATUS
Resident
35. On Original Return..........
.........................
.............................
................... FROM
TO
36. On This Return ...............
.........................
.............................
................... FROM
TO
EXEMPTIONS
37. Complete only if changing the number of exemptions. Enter a number for all that apply in the appropriate box (see instructions).
Enter the number of exemptions claimed:
On Your Original Return
On This Return
a. Number of federal exemptions. .................................. a.
a.
......................................
b. Deaf, blind or disabled * ............................................. b.
b.
......................................
c. Number of qualified disabled veterans. ...................... c.
c.
......................................
*Applies to people who are hemiplegic, paraplegic, quadriplegic or classified as totally and permanently disabled under Social Security guidelines.
38. List below all your dependents and answer all questions for each dependent (E-H answer “Yes” or “No”).
Attach separate sheet if necessary.
A
B
C
D
E
F
G
H
Did the
Was this
Did the dependent
Did you provide
dependent live
dependent
file a federal return
more than half the
with you more
claimed on
and claim exemption
dependent’s
than 6 months
your original
Name
Full Social Security Number
Relationship
Age
for self?
support?
during the year?
return?
EXPLANATION OF CHANGES
39. Explain change in number of dependents and changes to income, deductions and credits. Show computations in detail and attach
applicable schedules and supporting documentation if necessary.
Preparer Certification.
Taxpayer Certification.
I declare under penalty of perjury that the information in this
I declare under penalty of perjury that
return and attachments is true and complete to the best of my knowledge.
this return is based on all information of which I have any knowledge.
Filer’s Signature
Date
Preparer’s PTIN, FEIN or SSN
Preparer’s Business Name (print or type)
Spouse’s Signature
Date
Preparer’s Business Address (print or type)
By checking this box, I authorize Treasury to discuss my return with my
preparer.
Refund, credit, or zero returns. Mail your return to:
Michigan Department of Treasury, Lansing, MI 48956
Pay amount on line 33. Mail your check and return to: Michigan Department of Treasury, Lansing, MI 48929
Make check payable to “State of Michigan.” Print last four digits of your Social Security number, the tax year being amended and
“MI-1040X-12” on the front of your check. If paying on behalf of another taxpayer, write the filer’s name and the last four digits of their Social
Security number on the check. Do not staple your check to the return. Keep a copy of your return and all supporting schedules for six years
from the date filed or the due date, whichever is later.
+
0000 2014 10 02 27 8
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial