Form
1040X
(Rev. January 2018)
Department of the Treasury—Internal Revenue Service
Amended U.S. Individual Income Tax Return
Go to www.irs.gov/Form1040X for instructions and the latest information.
OMB No. 1545-0074
This return is for calendar year
2017 2016 2015 2014
Other year. Enter one: calendar year 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
Current 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 province/state/county Foreign postal code
Amended return filing status. You must check one box even if you are not changing
your filing status. Caution: In general, you can’t change your filing status from a joint
return to separate returns after the due date.
Single
Married filing jointly
Married filing separately
Qualifying widow(er)
Head of household (If the qualifying person is a child but not
your dependent, see instructions.)
Full-year coverage.
If all members of your household have full-
year minimal essential health care coverage,
check "Yes." Otherwise, check "No."
See instructions.
Yes No
Use Part III on the back to explain any changes
A. Original amount
or as previously
adjusted
(see instructions)
B. Net change—
amount of increase
or (decrease)—
explain in Part III
C. Correct
amount
Income and Deductions
Tax Liability
Payments
1 Adjusted gross income. If a net operating loss (NOL) carryback is
included, check here . . . . . . . . . . . . . . .
1
2 Itemized deductions or standard deduction . . . . . . . . . 2
3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . 3
4 Exemptions. If changing, complete Part I on page 2 and enter the
amount from line 29 . . . . . . . . . . . . . . . . .
4
5 Taxable income. Subtract line 4 from line 3 . . . . . . . . . . 5
Tax. Enter method(s) used to figure tax (see instructions):
6
7 Credits. If a general business credit carryback is included, check
here . . . . . . . . . . . . . . . . . . . . .
7
8 Subtract line 7 from line 6. If the result is zero or less, enter -0- . . . 8
9 Health care: individual responsibility (see instructions) . . . . . . 9
10 Other taxes . . . . . . . . . . . . . . . . . . . . 10
11 Total tax. Add lines 8, 9, and 10 . . . . . . . . . . . . . 11
12 Federal income tax withheld and excess social security and tier 1 RRTA
tax withheld. (If changing, see instructions.) . . . . . . . . .
12
13 Estimated tax payments, including amount applied from prior year’s
return . . . . . . . . . . . . . . . . . . . . . .
13
14 Earned income credit (EIC) . . . . . . . . . . . . . . . 14
15
Refundable credits from:
Schedule
8812
Form(s)
2439
4136 8863 8885 8962 or
other (specify):
15
16
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
17 Total payments. Add lines 12 through 15, column C, and line 16 . . . . . . . . . . . . . 17
Refund or Amount You Owe
18 Overpayment, if any, as shown on original return or as previously adjusted by the IRS . . . . . . 18
19 Subtract line 18 from line 17 (If less than zero, see instructions.) . . . . . . . . . . . . . 19
20
Amount you owe. If line 11, column C, is more than line 19, enter the difference . . . . . . . .
20
21 If line 11, column C, is less than line 19, enter the difference. This is the amount overpaid on this return 21
22 Amount of line 21 you want refunded to you . . . . . . . . . . . . . . . . . . . 22
23
Amount of line 21 you want applied to your
estimated tax .
(enter year): 23
Complete and sign this form on Page 2.
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11360L
Form
1040X (Rev. 1-2018)
6
Form 1040X (Rev. 1-2018)
Page 2
Part I Exemptions
Complete this part only if any information relating to exemptions has changed from what you reported on the return you are
amending. This would include a change in the number of exemptions, either personal exemptions or dependents.
See Form 1040 or Form 1040A instructions and Form 1040X instructions.
A. Original number
of exemptions or
amount reported or
as previously
adjusted
B. Net change
C. Correct
number
or amount
24 Yourself and spouse. Caution: If someone can claim you as a
dependent, you can’t claim an exemption for yourself . . . . . .
24
25 Your dependent children who lived with you . . . . . . . . . 25
26
Your dependent children who didn’t live with you due to divorce or separation
26
27 Other dependents . . . . . . . . . . . . . . . . . . 27
28 Total number of exemptions. Add lines 24 through 27 . . . . . . 28
29 Multiply the number of exemptions claimed on line 28 by the exemption
amount shown in the instructions for line 29 for the year you are
amending. Enter the result here and on line 4 on page 1 of this form. .
29
30
List ALL dependents (children and others) claimed on this amended return. If more than 4 dependents, see instructions.
(a) First name Last name
(b) Dependent’s social
security number
(c) Dependent’s
relationship to you
(d) Check box if qualifying
child for child tax credit
(see instructions)
Part II Presidential Election Campaign Fund
Checking below won’t increase your tax or reduce your refund.
Check here if you didn’t 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
Your occupation
Spouse’s signature. If a joint return, both must sign.
Date
Spouse’s occupation
Paid Preparer Use Only
Preparer’s signature
Date
Firm’s name (or yours if self-employed)
Print/type preparer’s name
Firm’s address and ZIP code
PTIN
Check if self-employed
Phone number EIN
For forms and publications, visit IRS.gov.
Form 1040X (Rev. 1-2018)