Form 1045 Application for Tentative Refund

1045

Form

Application for Tentative Refund
▶

Type or print

Department of the Treasury
Internal Revenue Service
Name(s) shown on return

OMB No. 1545-0098

2011

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

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, also complete spaces below (see instructions).

Daytime phone number

Foreign country name

Foreign postal code

1 This application is filed
to carry back:

Foreign province/county

a Net operating loss (NOL) (Sch. A, line 25, page 2) b Unused general business credit
$
$

c Net section 1256 contracts loss

$
b Date tax return was filed

2a

For the calendar year 2011, or other tax year

3
4

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 ▶
and b Year(s) ▶
If SSN for carryback year is different from above, enter a SSN ▶
▶
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

beginning

5
6
7
8
9

, 2011, and ending

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

, 20

preceding

preceding

preceding

tax year ended ▶

tax year ended ▶

tax year ended ▶

Before
carryback

After
carryback

Before
carryback

After
carryback

10
11
12
13
14
15
16

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 . . . . . .

17
18
19
20
21
22
23
24
25
26

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

27
28

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)

Keep a copy of
this application
for your records.

Paid
Preparer
Use Only

.

.

After
carryback

.

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
▲ ▲

Sign
Here

Before
carryback

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

Print/Type preparer’s name

Preparer’s signature

Firm’s name ▶
Firm’s address ▶

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

Date
Date

Check
if
self-employed

PTIN

Firm's EIN ▶
Phone no.
Cat. No. 10670A

Form 1045 (2011)

Page 2

Form 1045 (2011)

Schedule A—NOL (see instructions)
1

Enter the amount from your 2011 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
3
4
5

Nonbusiness capital losses before limitation. Enter as a positive number
Nonbusiness capital gains (without regard to any section 1202 exclusion)
If line 2 is more than line 3, enter the difference. Otherwise, enter -0- . .
If line 3 is more than line 2, enter the difference.
Otherwise, enter -0- . . . . . . . . .
5
Nonbusiness deductions (see instructions) . . . . . . . . . . .
Nonbusiness income other than capital gains (see
instructions) . . . . . . . . . . . .
7
Add lines 5 and 7 . . . . . . . . . . . . . . . . . . .
If line 6 is more than line 8, enter the difference. Otherwise, enter -0- . .
If line 8 is more than line 6, enter the difference.
Otherwise, enter -0-. But do not enter more
than line 5 . . . . . . . . . . . .
10
Business capital losses before limitation. Enter as a positive number . .
Business capital gains (without regard to any
section 1202 exclusion) . . . . . . . .
12
Add lines 10 and 12 . . . . . . . . . . . . . . . . . .
Subtract line 13 from line 11. If zero or less, enter -0- . . . . . . .
Add lines 4 and 14 . . . . . . . . . . . . . . . . . . .

6
7
8
9
10

11
12
13
14
15
16

17
18
19

20
21
22
23
24
25

1

2
3
4

6

8
. .

.

.

.

.

.

9

Section 1202 exclusion. Enter as a positive number . . . . . . . . . . . .
Subtract line 17 from line 16. If zero or less, enter -0- . . . . . . .
18
Enter the loss, if any, from line 21 of your 2011 Schedule D (Form 1040).
(Estates and trusts, enter the loss, if any, from line 16 of Schedule D (Form
1041).) Enter as a positive number
. . . . . . . . . . . . .
19
If line 18 is more than line 19, enter the difference. Otherwise, enter -0- .
20
If line 19 is more than line 18, enter the difference. Otherwise, enter -0- . . . . .
Subtract line 20 from line 15. If zero or less, enter -0- . . . . . . . . . . .
Domestic production activities deduction from your 2011 Form 1040, line 35, or Form
34 (or included on Form 1041, line 15a) . . . . . . . . . . . . . . . .

.

.

.

.

17

.
.
line
.

21
22

Enter the loss, if any, from line 16 of your 2011 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 . . . . . .

.

11

13
14
15

16

. . .
. . .
1040NR,
. . .

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 . . . . . . . . . .

23
24
25
Form 1045 (2011)

Page 3

Form 1045 (2011)

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

NOL deduction
(see instructions).
Enter as a positive number . . . .

2

Taxable income before 2011 NOL
carryback (see instructions). Estates
and trusts, increase this amount by the
sum of the charitable deduction and
income distribution deduction . . .
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) . . . . . . . . .

3
4
5
6
7
8

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 .

9

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

10

11
12
13
14
15

NOL carryover (see instructions). .

preceding
tax year ended ▶

.

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 -0- . . . . . . . .

18
19

Subtract 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) . . . .

21

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 2011
NOL carryback . . . . . . . .

16
17

20

preceding
tax year ended ▶

Subtract line 20 from line 19

.

.

.
Form 1045 (2011)

Page 4

Form 1045 (2011)

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 2011 that
was deducted to figure line 11 on page
3 of the form . . . . . . . . .

24
25

Add lines 22 and 23 . . . . . .
Charitable contributions from Sch. A
(Form 1040), line 19 (line 18 for 2001
through 2006), or Sch. A (Form 1040NR),
line 7 (or as previously adjusted) . . .
Refigured charitable contributions (see
instructions) . . . . . . . . .

26
27
28

Subtract line 26 from line 25
. . .
Casualty and theft losses from Form
4684, line 21 (line 23 for 2008; line 18
for 2001 through 2004 and 2007; line
20 for 2005 and 2006) . . . . . .

29

Casualty and theft losses from Form
4684, 17 (line 18 for 2005, 2006, and
2009); (line 21 for 2008; line 16 for 2001
through 2004 and 2007) . . . . .

30
31

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

32
33

Subtract line 31 from line 28
. . .
Miscellaneous itemized deductions from
Sch. A (Form 1040), line 27 (line 26 for 2001
through 2006), or Sch. A (Form 1040NR),
line 15 (or as previously adjusted) . . .

34

Miscellaneous itemized deductions from
Sch. A (Form 1040), line 24 (line 23 for 2001
through 2006), or Sch. A (Form 1040NR),
line 12 (or as previously adjusted) . . .

35
36

Multiply line 22 by 2% (.02) . . . .
Subtract line 35 from line 34. If zero or
less, enter -0- . . . . . . . .

37

Subtract line 36 from line 33

38

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).
• $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)

.

.

preceding

preceding

preceding

tax year ended ▶

tax year ended ▶

tax year ended ▶

.

Form 1045 (2011)