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

Form

1040X

(Rev. December 2012)

Department of the Treasury—Internal Revenue Service

Amended U.S. Individual Income Tax Return
▶

OMB No. 1545-0074

Information about Form 1040X and its separate instructions is at www.irs.gov/form1040x.

This return is for calendar year
2012
Other year. Enter one: calendar year

2011

2010

2009

or fiscal year (month and 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 (number and street). If you have a P.O. box, see instructions.

Apt. no.

Your phone number

City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions).
Foreign country name

Foreign postal code

Foreign province/state/county

Amended return filing status. You must check one box even if you are not changing your filing status.
Caution. In general, 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 instructions.)
A. Original amount B. Net change—
or as previously
amount of increase
adjusted
or (decrease)—
(see instructions)
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. If net operating loss (NOL) carryback is
included, check here . . . . . . . . . . . . . . . ▶
Itemized deductions or standard deduction
. . . . . . . . .
Subtract line 2 from line 1 . . . . . . . . . . . . . . .
Exemptions. If changing, complete Part I on page 2 and enter the
amount from line 30 . . . . . . . . . . . . . . . . .
Taxable income. Subtract line 4 from line 3 . . . . . . . . . .

C. Correct
amount

1
2
3
4
5

Tax Liability
6

Tax. Enter method used to figure tax:

7

Credits. 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 . . . . . . . . . . . . . . . . . . . .
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 instructions) . . . . . . . . . .
Estimated tax payments, including amount applied from prior year’s
return . . . . . . . . . . . . . . . . . . . . . .
Earned income credit (EIC) . . . . . . . . . . . . . . .
Refundable credits from Schedule(s)
8812 or
M or Form(s)
2439
4136
8885 or

5405
8801
other (specify):

8812 (2009–2011)

8839

11
12
13

8863

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 . . . . . . . . . . . . . . . . . . . . . . . .
16
Total payments. Add lines 11 through 15 . . . . . . . . . . . . . . . . . . . .
Refund or Amount You Owe (Note. Allow 8–12 weeks to process Form 1040X.)
Overpayment, if any, as shown on original return or as previously adjusted by the IRS . . . . . .
17
18
Subtract line 17 from line 16 (If less than zero, see instructions) . . . . . . . . . . . . .
19
Amount you owe. If line 10, column C, is more than line 18, enter the difference
. . . . . . . .
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 . . . . . . . . . . . . . . . . . . .
22
Amount of line 20 you want applied to your (enter year):
estimated tax . 22
15

15
16
17
18
19
20
21

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

Cat. No. 11360L

Form 1040X (Rev. 12-2012)

Page 2

Form 1040X (Rev. 12-2012)

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 2009.
A. Original number
of exemptions or
amount reported or
as previously
adjusted

See Form 1040 or Form 1040A instructions and Form 1040X instructions.
23

C. Correct
number
or amount

B. Net change

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 . . . . . . . . . . . . . . . . . . . . .

28

29

If you are claiming an exemption amount for housing individuals
displaced by a Midwestern disaster, enter the amount from Form 8914,
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 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
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. 12-2012)