Form 1045 Application for Tentative Refund

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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1045, PAGE 1 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 203 mm (8") 3 559 mm (22"), FOLD TO: 203 mm (8") 3 279 mm (11")
PERFORATE: ON TOP FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Date

Form

©

Revised proofs
requested

OMB No. 1545-0098

See separate instructions.
Do not attach to your income tax return—mail in a separate envelope.
© For use by individuals, estates, or trusts.

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Number, street, and apt. or suite no. If a P.O. box, see page 4 of the instructions.

Spouse’s social security number (SSN)

City, town or post office, state, and ZIP code. If a foreign address, see page 4 of the instructions.

Daytime phone number

a Net operating loss (NOL) (Sch. A, line 25, page 2)

This application is
filed to carry back:

$

2a For the calendar year 2009, or other tax year
beginning

5
6
7
8
9

, 2009, and ending

(see page 4 of the instructions)
Note: If 1a and 1c are blank, skip lines 10 through 15.

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12
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15
16
17
18
19
20
21
22
23
24
25
26

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b Unused general business credit
$

)

c Net section 1256 contracts loss

$
b Date tax return was filed

, 20

If this application is for an unused credit created by another carryback, enter year of first carryback ©
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 ©
If SSN for carryback year is different from above, enter a SSN ©
and b Year(s) ©
If you changed your accounting period, give date permission to change was granted ©
Have you filed a petition in Tax Court for the year(s) to which the carryback is to be applied?
Yes
No
Is any part of the decrease in tax due to a loss or credit from a tax shelter required to be registered?
Yes
No
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 page 4 of the instructions)?
Yes
No

Computation of Decrease in Tax

10

2009

Social security or employer identification number

(

3
4

Signature

O.K. to print

©

Name(s) shown on return

1

Date

Application for Tentative Refund

1045

Department of the Treasury
Internal Revenue Service

Type or print

Action

preceding
tax year ended ©
Before
carryback

preceding
tax year ended ©
After
carryback

Before
carryback

preceding
tax year ended ©
After
carryback

Before
carryback

After
carryback

NOL deduction after carryback (see
page 4 of the instructions)
Adjusted gross income
Deductions (see page 6 of the instructions)
Subtract line 12 from line 11
Exemptions (see page 6 of the instructions)
Taxable income. Line 13 minus line 14
Income tax. See page 6 of the
instructions and attach an explanation
Alternative minimum tax
Add lines 16 and 17
General business credit (see page 7
of the 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)

Sign
Here
Keep a copy of
this application
for your records.

Preparer Other
Than Taxpayer

Under penalties of perjury, I declare that I have examined this application and accompanying schedules and statements, and to the best of my
knowledge and belief, they are true, correct, and complete.

©
©

Your signature

Date

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

Date

Name

Date

©

Address

©

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice,
see page 11 of the instructions.

Cat. No. 10670A

Form

1045

(2009)

2
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1045, PAGE 2 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 203 mm (8") 3 559 mm (22"), FOLD TO: 203 mm (8") 3 279 mm (11")
PERFORATE: ON TOP FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1045 (2009)

Page

2

Schedule A—NOL (see page 7 of the instructions)
1

2
3
4
5
6
7
8
9
10

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12
13
14
15
16

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Enter the amount from your 2009 Form 1040, line 41, or Form 1040NR, line 38, minus any amount
on Form 8914, line 6. Estates and trusts, enter taxable income increased by the total of the charitable
deduction, income distribution deduction, and exemption amount
2
Nonbusiness capital losses before limitation. Enter as a positive number
3
Nonbusiness capital gains (without regard to any section 1202 exclusion)
4
If line 2 is more than line 3, enter the difference; otherwise, enter -0If line 3 is more than line 2, enter the difference;
5
otherwise, enter -06
Nonbusiness deductions (see page 7 of the instructions)
Nonbusiness income other than capital gains
7
(see page 8 of the instructions)
8
Add lines 5 and 7
If line 6 is more than line 8, enter the difference; otherwise, enter -0If line 8 is more than line 6, enter the difference;
otherwise, enter -0-. But do not enter more than
10
line 5
Business capital losses before limitation. Enter as a positive number
Business capital gains (without regard to any
12
section 1202 exclusion)
Add lines 10 and 12
Subtract line 13 from line 11. If zero or less, enter -0Add lines 4 and 14

13
14
15

16

17
18

Section 1202 exclusion. Enter as a positive number
Subtract line 17 from line 16. If zero or less, enter -0-

18

19

Enter the loss, if any, from line 21 of your 2009 Schedule D (Form 1040).
(Estates and trusts, enter the loss, if any, from line 16 of Schedule D
19
(Form 1041).) Enter as a positive number
20
If line 18 is more than line 19, enter the difference; otherwise, enter -0If line 19 is more than line 18, enter the difference; otherwise, enter -0Subtract line 20 from line 15. If zero or less, enter -0Domestic production activities deduction from your 2009 Form 1040, line 35, or Form 1040NR, line
33 (or included on Form 1041, line 15a)
NOL deduction for losses from other years. Enter as a positive number
NOL. Combine lines 1, 9, 17, and 21 through 24. If the result is less than zero, enter it here and on
page 1, line 1a. If the result is zero or more, you do not have an NOL

24
25

9

11

Enter the loss, if any, from line 16 of your 2009 Schedule D (Form 1040).
(Estates and trusts, enter the loss, if any, from line 15, column (3), of
Schedule D (Form 1041).) Enter as a positive number. If you do not have
a loss on that line (and do not have a section 1202 exclusion), skip lines
16 through 21 and enter on line 22 the amount from line 15

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21
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23

1

17

21
22
23
24
25
Form

1045

(2009)

2
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1045, PAGE 3 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 203 mm (8") 3 559 mm (22"), FOLD TO: 203 mm (8") 3 279 mm (11")
PERFORATE: ON TOP FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1045 (2009)

Page

3

Schedule B—NOL Carryover (see page 8 of the instructions)
Complete one column before going to the
next column. Start with the earliest
carryback year.
1

NOL deduction (see page 8 of the
instructions). Enter as a positive number

2

Taxable income before 2009 NOL
carryback (see page 8 of the
instructions). Estates and trusts,
increase this amount by the sum of the
charitable deduction and income
distribution deduction
Net capital loss deduction (see page
8 of the instructions)
Section 1202 exclusion. Enter as a
positive number
Domestic
production
activities
deduction
Adjustment to adjusted gross income
(see page 8 of the instructions)
Adjustment to itemized deductions
(see page 8 of the instructions)

3
4
5
6
7
8

Individuals,
enter
deduction
for
exemptions (minus any amount on
Form 8914, line 6, for 2006; line 2 for 2005
and 2008). Estates and trusts, enter
exemption amount

9

Modified taxable income. Combine
lines 2 through 8. If zero or less,
enter -0-

10

NOL carryover (see page 9 of the
instructions). Subtract line 9 from line
1. If zero or less, enter -0-

11
12
13
14
15
16
17
18
19
20
21

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preceding
tax year ended ©

preceding
tax year ended ©

preceding
tax year ended ©

Adjustment to Itemized
Deductions (Individuals Only)
Complete lines 11 through 38 for the
carryback year(s) for which you
itemized deductions only if line 3, 4,
or 5 above is more than zero.
Adjusted gross income before 2009
NOL carryback
Add lines 3 through 6 above
Modified adjusted gross income. Add
lines 11 and 12
Medical expenses from Sch. A (Form
1040), line 4 (or as previously adjusted)
Medical expenses from Sch. A (Form
1040), line 1 (or as previously adjusted)
Multiply line 13 by 7.5% (.075)
Subtract line 16 from line 15. If zero
or less, enter -0Subtract line 17 from line 14
Qualified
mortgage
insurance
premiums from Sch. A (Form 1040),
line 13 (or as previously adjusted)
Refigured qualified mortgage insurance
premiums (see instructions)
Subtract line 20 from line 19
Form

1045

(2009)

2
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1045, PAGE 4 of 4
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 203 mm (8") 3 559 mm (22"), FOLD TO: 203 mm (8") 3 279 mm (11")
PERFORATE: ON TOP FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 1045 (2009)

Page

4

Schedule B—NOL Carryover (Continued)
Complete one column before going to the
next column. Start with the earliest
carryback year.
22

Modified adjusted gross income
from line 13 on page 3

23

Enter as a positive number any NOL
carryback from a year before 2009
that was deducted to figure line 11
on page 3
Add lines 22 and 23

24
25

Charitable contributions from Sch. A
(Form 1040), line 18 (line 19 for 2007
and 2008), or Sch. A (Form 1040NR),
line 7 (or as previously adjusted)

26

Refigured charitable contributions
(see page 9 of the instructions)
Subtract line 26 from line 25

27
28

Casualty and theft losses from Form
4684, line 18 (line 20 for 2005 and 2006;
line 23 for 2008) (or as previously
adjusted)

29

Casualty and theft losses from Form
4684, line 16 (line 18 for 2005 and 2006;
line 21 for 2008) (or as previously
adjusted)

30
31

Multiply line 22 by 10% (.10)
Subtract line 30 from line 29. If zero
or less, enter -0Subtract line 31 from line 28

32
33

Miscellaneous itemized deductions from
Sch. A (Form 1040), line 26 (line 27 for
2007 and 2008), or Sch. A (Form 1040NR),
line 15 (or as previously adjusted)

34

Miscellaneous itemized deductions from
Sch. A (Form 1040), line 23 (line 24 for
2007 and 2008), or Sch. A (Form 1040NR),
line 12 (or as previously adjusted)
Multiply line 22 by 2% (.02)
Subtract line 35 from line 34. If zero
or less, enter -0Subtract line 36 from line 33
Complete the worksheet on page 10
of the instructions if line 22 is more
than the applicable amount shown
below (more than one-half that
amount if married filing separately for
that year).
● $126,600 for 1999.
● $128,950 for 2000.
● $132,950 for 2001.
● $137,300 for 2002.
● $139,500 for 2003.
● $142,700 for 2004.
● $145,950 for 2005.
● $150,500 for 2006.
● $156,400 for 2007.
● $159,950 for 2008.

35
36
37
38

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preceding
tax year ended ©

preceding
tax year ended ©

preceding
tax year ended ©

Otherwise, combine lines 18, 21, 27,
32, and 37; enter the result here and
on line 7 (page 3)
Printed on recycled paper

Form

1045

(2009)