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

Form

1040X

(Rev. December 2010)

Department of the Treasury—Internal Revenue Service

Amended U.S. Individual Income Tax Return
▶

This return is for calendar year
2010
Other year. Enter one: calendar year

2009

OMB No. 1545-0074

See separate instructions.
2008

2007

or fiscal year (month and year ended):

Your first name and middle initial

Your last name

Your social security number

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

Your spouse's last name

Your spouse’s social security number

Your current home address (number and street). If you have a P.O. box, see page 5 of instructions.

Apt. no.

Your phone number

Your city, town or post office, state, and ZIP code. If you have a foreign address, see page 5 of instructions.

Amended return filing status. You must check one box even if you are not changing your filing status.
Caution. You cannot change your filing status from joint to separate returns after the due date.
Single
Qualifying widow(er)

Married filing jointly
Married filing separately
Head of household (If the qualifying person is a child but not your dependent, see page 5 of instructions.)
A. Original amount B. Net change—
or as previously
amount of increase
adjusted
or (decrease)—
(see page 6)
explain in Part III

Use Part III on the back to explain any changes
Income and Deductions
1
2
3
4
5

Adjusted gross income (see page 6 of instructions). If net operating loss
(NOL) carryback is included, check here . . . . . . . . . ▶
Itemized deductions or standard deduction (see page 7 of instructions)
Subtract line 2 from line 1 . . . . . . . . . . . . . . .
Exemptions. If changing, complete Part I on the back and enter the
amount from line 30 (see page 7 of instructions)
. . . . . . .
Taxable income. Subtract line 4 from line 3 . . . . . . . . . .

C. Correct
amount

1
2
3
4
5

Tax Liability
6

Tax (see page 8 of instructions). Enter method used to figure tax:

7

Credits (see page 8 of instructions). If general business credit carryback
is included, check here . . . . . . . . . . . . . . ▶
Subtract line 7 from line 6. If the result is zero or less, enter -0- . . .
Other taxes (see page 8 of instructions) . . . . . . . . . . .
Total tax. Add lines 8 and 9 . . . . . . . . . . . . . . .

6

8
9
10

7
8
9
10

Payments
11
12
13
14

Federal income tax withheld and excess social security and tier 1 RRTA
tax withheld (if changing, see page 8 of instructions) . . . . . .
Estimated tax payments, including amount applied from prior year’s
return (see page 9 of instructions) . . . . . . . . . . . . .
Earned income credit (EIC) (see page 9 of instructions) . . . . . .
Refundable credits from
Schedule M or Form(s)
2439
4136
5405
8801
other (specify):

8812

8839

8863

11
12
13

8885 or

14
Total amount paid with request for extension of time to file, tax paid with original return, and additional
tax paid after return was filed (see page 10 of instructions)
. . . . . . . . . . . . . .
16
Total payments. Add lines 11 through 15 . . . . . . . . . . . . . . . . . . . .
Refund or Amount You Owe (Note. Allow 8–12 weeks to process Form 1040X.)
17
Overpayment, if any, as shown on original return or as previously adjusted by the IRS (see page 10
of instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18
Subtract line 17 from line 16 (If less than zero, see page 10 of instructions) . . . . . . . . .
19
Amount you owe. If line 10, column C, is more than line 18, enter the difference (see page 10 of instructions)
20
If line 10, column C, is less than line 18, enter the difference. This is the amount overpaid on this return
21
Amount of line 20 you want refunded to you . . . . . . . . . . . . . . . . . . .
Amount of line 20 you want applied to your (enter year):
estimated tax
22
22
15

15
16

17
18
19
20
21

Complete and sign this form on Page 2.
For Paperwork Reduction Act Notice, see page 11 of instructions.

Cat. No. 11360L

Form 1040X (Rev. 12-2010)

Page 2

Form 1040X (Rev. 12-2010)

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, or
• Increasing or decreasing the exemption amount for housing individuals displaced by a Midwestern disaster in 2008 or 2009.
See Form 1040 or Form 1040A instructions and page 11 of Form 1040X instructions.
23

A. Original number
of exemptions or
amount reported or
as previously
adjusted

B. Net change

C. Correct
number
or amount

Yourself and spouse. Caution. If someone can claim you as a
dependent, you cannot claim an exemption for yourself . . . . . .
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 23 through 26 . . . . . .

23
24
25
26
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 (see page 11 of instructions) . . . . . . . . . . .

28

29

If you are claiming an exemption amount for housing individuals
displaced by a Midwestern disaster, enter the amount from Form 8914,
line 2 for 2008, or line 6 for 2009 . . . . . . . . . . . . .
29
Add lines 28 and 29. Enter the result here and on line 4 on page 1 of this form
30
List ALL dependents (children and others) claimed on this amended return. If more than 4 dependents, see page 11 of instructions.

24
25
26
27

30
31

(a) First name

Part II

(b) Dependent’s social
security number

Last name

(c) Dependent’s

relationship to you

(d) Check box if qualifying
child for child tax credit (see
page 11 of instructions)

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

Firm’s name (or yours if self-employed)

Date

Paid Preparer Use Only
▲

Preparer’s signature
Print/type preparer's name

Firm's address and ZIP code
Check if self-employed

PTIN

For forms and publications, visit IRS.gov.

Phone number

EIN
Form 1040X (Rev. 12-2010)