Form 1040 X Amended U.S. Individual Income Tax Return

Form

1040X

Department of the Treasury—Internal Revenue Service

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(Rev. February 2009)

This return is for calendar year
Please print or type

OMB No. 1545-0074

Amended U.S. Individual Income Tax Return
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See separate instructions.

, or fiscal year ended

©

,

.

Your first name and initial

Last name

Your social security number

If a joint return, spouse’s first name and initial

Last name

Spouse’s social security number

Home address (no. and street) or P.O. box if mail is not delivered to your home

Apt. no.

Phone number

(

)

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

A If the address shown above is different from that shown on your last return filed with the IRS, would you like us to change it
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Yes
No
in our records?
B Filing status. Be sure to complete this line. Note. You cannot change from joint to separate returns after the due date.
On original return

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Single

Married filing jointly

Married filing separately

On this return ©
Single
Married filing jointly
Married filing separately
* If the qualifying person is a child but not your dependent, see page 4 of the instructions.

Income and Deductions (see instructions)

Tax Liability

5

11

Federal income tax withheld and excess social security and
11
tier 1 RRTA tax withheld. If changing, see page 6
Estimated tax payments, including amount applied from prior
12
year’s return
13
Earned income credit (EIC)
14
Additional child tax credit from Form 8812
Credits: Recovery rebate; federal telephone excise tax; or from
15
Forms 2439, 4136, 5405, 8885, or 8801 (refundable credit only)
Amount paid with request for extension of time to file (see page 6)
Amount of tax paid with original return plus additional tax paid after it was filed
Total payments. Add lines 11 through 17 in column C

16
17
18

C. Correct
amount

4
5
6
7
8
9
10

Tax (see page 5). Method used in col. C
Credits (see page 6)
Subtract line 7 from line 6. Enter the result but not less than zero
Other taxes (see page 6)
Total tax. Add lines 8 and 9

13
14
15

Qualifying widow(er)

1
2
3

6
7
8
9
10

12
Payments

Adjusted gross income (see page 4)
Itemized deductions or standard deduction (see page 4)
Subtract line 2 from line 1
Exemptions. If changing, fill in Parts I and II on the back
(see page 5)
Taxable income. Subtract line 4 from line 3

Qualifying widow(er)

Head of household*

B. Net change—
A. Original amount or
amount of increase
as previously adjusted
or (decrease)—
(see page 4)
explain in Part II

Use Part II on the back to explain any changes
1
2
3
4

Head of household

16
17
18

Refund or Amount You Owe
Note. Allow 8-12 weeks to process Form 1040X.
19
20
21
22
23
24

19
20
21
22
23

Overpayment, if any, as shown on original return or as previously adjusted by the IRS
Subtract line 19 from line 18 (see page 6)
Amount you owe. If line 10, column C, is more than line 20, enter the difference and see page 6
If line 10, column C, is less than line 20, enter the difference
Amount of line 22 you want refunded to you
Amount of line 22 you want applied to your
estimated tax
24

Sign
Here

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 of which the preparer has any knowledge.

Joint return?
See page 4.
Keep a copy for
your records.

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Paid
Preparer’s
Use Only

Your signature

Preparer’s
signature

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Firm’s name (or
yours if self-employed),
address, and ZIP code

Date

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Spouse’s signature. If a joint return, both must sign.

Date

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For Paperwork Reduction Act Notice, see page 8 of instructions.

Check if
self-employed

Date

Preparer’s SSN or PTIN

EIN
Phone no. (
Cat. No. 11360L

)
Form

1040X

(Rev. 2-2009)

Form 1040X (Rev. 2-2009)

Part I

Page

Exemptions. See Form 1040 or 1040A instructions.

Complete this part only if you are:
● Increasing or decreasing the number of exemptions claimed on line 6d
of the return you are amending, or
● Increasing or decreasing the exemption amount for housing individuals
displaced by Hurricane Katrina or for housing Midwestern displaced individuals.
25

A. Original
number of
exemptions
reported or as
previously
adjusted

B. Net change

2

C. Correct
number of
exemptions

25

Yourself and spouse
Caution. If someone can claim you as a dependent, you cannot claim an
exemption for yourself.

26
27
28
29
30

Your dependent children who lived with you
Your dependent children who did not live with you due to divorce or
separation
Other dependents
Total number of exemptions. Add lines 25 through 28
Multiply the number of exemptions claimed on line 29 by the amount listed
below for the tax year you are amending. Enter the result here.
Tax
year
2008
2007
2006
2005

31

Exemption
amount
$3,500
3,400
3,300
3,200

26
27
28
29

But see the instructions for
line 4 on page 5 if the
amount on line 1 is over:
$119,975
117,300
112,875
109,475

If you are claiming an exemption amount for housing individuals displaced by
Hurricane Katrina, enter the amount from Form 8914, line 2 for 2005 or line 6
for 2006. If you are claiming an exemption amount for housing Midwestern
displaced individuals, enter the amount from the 2008 Form 8914, line 2. (See
instructions for line 4). Otherwise enter -0-

30

31
32

32

Add lines 30 and 31. Enter the result here and on line 4

33

Dependents (children and other) not claimed on original (or adjusted) return:
(b) Dependent’s social
security number
(a) First name

Last name

if qualifying
(c) Dependent’s (d)
relationship to you child for child tax
credit (see page 7)

No. of children
on 33 who:
● lived with
you

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● did not live
with you due to
divorce or
separation (see
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page 7)
Dependents
on 33 not
entered above

Part II

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Explanation of Changes
Enter the line number from the front of the form for each item you are changing and give the reason for each change.
Attach only the supporting forms and schedules for the items changed. If you do not attach the required information,
your Form 1040X may be returned. Be sure to include your name and social security number on any attachments.

If the change relates to a net operating loss carryback or a general business credit carryback, attach the schedule or form
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that shows the year in which the loss or credit occurred. See pages 2 and 3 of the instructions. Also, check here

Part III Presidential Election Campaign Fund. Checking below will not increase your tax or reduce your refund.
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If you did not previously want $3 to go to the fund but now want to, check here
If a joint return and your spouse did not previously want $3 to go to the fund but now wants to, check here
Form

©

1040X

(Rev. 2-2009)