Form 1045 Application for Tentative Refund

Form

Application for Tentative Refund

1045
©

Department of the Treasury
Internal Revenue Service

Type or print

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.

Name(s) shown on return

Social security or employer identification number

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

Spouse’s social security number (SSN)

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

Daytime phone number

(
1

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

This application is
filed to carry back:

$

beginning

$

5
6
7
8
9

, 2010, and ending

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

11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

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 resulting from a reportable transaction required to
be disclosed on Form 8886, Reportable Transaction Disclosure Statement?
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 instructions)?
Yes
No

Computation of Decrease in Tax

10

)

b Unused general business credit

2a For the calendar year 2010, or other tax year

3
4

2010

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
instructions)
Adjusted gross income
Deductions (see instructions)
Subtract line 12 from line 11
Exemptions (see instructions)
Taxable income. Line 13 minus line 14
Income tax. See instructions and
attach an explanation
Alternative minimum tax
Add lines 16 and 17
General
business
credit
(see
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

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.

Keep a copy of
this application
for your records.

©
©

Your signature

Date

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

Date

Print/Type preparer’s name

Paid
Preparer
Use Only

Firm’s name

Preparer’s signature

©

Firm’s address

Date

Check
if
self-employed
Firm’s EIN

©

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.

PTIN

©

Phone no.
Cat. No. 10670A

Form

1045

(2010)

Form 1045 (2010)

Page

2

Schedule A—NOL (see instructions)
1

2
3
4
5
6
7
8
9
10

11
12
13
14
15
16

Enter the amount from your 2010 Form 1040, line 41, or Form 1040NR, line 39. 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 instructions)
Nonbusiness income other than capital gains
7
(see 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 2010 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 2010 Form 1040, line 35, or Form 1040NR, line
34 (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 2010 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

20
21
22
23

1

17

21
22
23
24
25
Form

1045

(2010)

Form 1045 (2010)

Page

3

Schedule B—NOL Carryover (see instructions)
Complete one column before going to the
next column. Start with the earliest
carryback year.
1
2

3
4
5
6
7

9

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

12
13
14
15
16
17
18
19
20
21

preceding
tax year ended ©

Net capital loss deduction (see
instructions)
Section 1202 exclusion. Enter as a
positive number
Domestic production activities
deduction
Adjustment to adjusted gross income
(see instructions)
Adjustment to itemized deductions
(see instructions)
Individuals, enter deduction for
exemptions (minus any amount on
Form 8914, line 6, for 2006 and
2009; line 2 for 2005 and 2008).
Estates and trusts, enter exemption
amount

11

preceding
tax year ended ©

NOL deduction (see instructions). Enter
as a positive number
Taxable income before 2010 NOL
carryback (see instructions). Estates
and trusts, increase this amount by
the sum of the charitable deduction
and income distribution deduction

8

10

preceding
tax year ended ©

NOL carryover (see instructions).
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 2010
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
Mortgage insurance premiums from
Sch. A (Form 1040), line 13 (or as
previously adjusted)
Refigured
mortgage
insurance
premiums (see instructions)
Subtract line 20 from line 19
Form

1045

(2010)

Form 1045 (2010)

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 of the form

23

Enter as a positive number any NOL
carryback from a year before 2010
that was deducted to figure line 11
on page 3 of the form
Add lines 22 and 23

24
25

Charitable contributions from Sch. A
(Form 1040), line 19 (line 18 for 2000
through 2006), or Sch. A (Form
1040NR), line 7 (or as previously
adjusted)

26

Refigured charitable contributions
(see instructions)
Subtract line 26 from line 25

27
28

29

30
31
32
33

34

35
36
37
38

preceding
tax year ended ©

preceding
tax year ended ©

preceding
tax year ended ©

Casualty and theft losses from Form
4684, line 21 (line 23 for 2008; line 18
for 2000 through 2004 and 2007; line
20 for 2005 and 2006)
Casualty and theft losses from Form
4684, line 18 (line 21 for 2008; line 16
for 2000 through 2004 and 2007)
Multiply line 22 by 10% (.10)
Subtract line 30 from line 29. If zero
or less, enter -0Subtract line 31 from line 28
Miscellaneous itemized deductions from
Sch. A (Form 1040), line 27 (line 26 for 2000
through 2006), or Sch. A (Form 1040NR),
line 15 (or as previously adjusted)
Miscellaneous itemized deductions from
Sch. A (Form 1040), line 24 (line 23 for 2000
through 2006), 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 in 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).
● $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.
● $166,800 for 2009.
Otherwise, combine lines 18, 21, 27,
32, and 37; enter the result here and
on line 7 (page 3)
Form

1045

(2010)