Department of the Treasury—Internal Revenue Service
OMB No. 1545-0074
Amended U.S. Individual Income Tax Return
Form
(Rev. February 2009)
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See separate instructions.
This return is for calendar year
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, or fiscal year ended
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, .
Your social security number
Last name
Your first name and initial
Last name
If a joint return, spouse’s first name and initial
Spouse’s social security number
Apt. no.
Home address (no. and street) or P.O. box if mail is not delivered to your home
Phone number
( )
Please print or type
City, town or post office, state, and ZIP code. If you have a foreign address, see page 4 of the instructions.
A
B
Filing status. Be sure to complete this line. Note. You cannot change from joint to separate returns after the due date.
Qualifying widow(er)
Head of household
Married filing separately
Married filing jointly
Single
On original return
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Qualifying widow(er)
Head of household*
Married filing separately
Married filing jointly
Single
On this return
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B. Net change—
amount of increase
or (decrease)—
explain in Part II
A. Original amount or
as previously adjusted
(see page 4)
Income and Deductions (see instructions)
C. Correct
amount
1
1
Adjusted gross income (see page 4)
2
2
Itemized deductions or standard deduction (see page 4)
3
3
Subtract line 2 from line 1
4
Exemptions. If changing, fill in Parts I and II on the back
(see page 5)
4
5
Taxable income. Subtract line 4 from line 3
5
6
6
Tax (see page 5). Method used in col. C
7
7
Credits (see page 6)
8
8
Subtract line 7 from line 6. Enter the result but not less than zero
9
Other taxes (see page 6)
9
Tax Liability
Total tax. Add lines 8 and 9
10
10
11
11
Federal income tax withheld and excess social security and
tier 1 RRTA tax withheld. If changing, see page 6
12
12
Estimated tax payments, including amount applied from prior
year’s return
13
13
Earned income credit (EIC)
15
Credits: Recovery rebate; federal telephone excise tax; or from
Forms 2439, 4136, 5405, 8885, or 8801 (refundable credit only)
15
16
Amount paid with request for extension of time to file (see page 6)
16
Payments
17
Amount of tax paid with original return plus additional tax paid after it was filed
17
18
18
Total payments. Add lines 11 through 17 in column C
Refund or Amount You Owe
19
19
Overpayment, if any, as shown on original return or as previously adjusted by the IRS
20
20
Subtract line 19 from line 18 (see page 6)
21
21
Amount you owe. If line 10, column C, is more than line 20, enter the difference and see page 6
22
22
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 of which the preparer has any knowledge.
Sign
Here
Your signature
Date
Spouse’s signature. If a joint return, both must sign.
Date
Preparer’s SSN or PTIN
Date
Preparer’s
signature
Check if
self-employed
Paid
Preparer’s
Use Only
Firm’s name (or
yours if self-employed),
address, and ZIP code
EIN
Phone no. ( )
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Cat. No. 11360L
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Joint return?
See page 4.
Keep a copy for
your records.
Form 1040X (Rev. 2-2009)
Use Part II on the back to explain any changes
23
23
Amount of line 22 you want refunded to you
24
Amount of line 22 you want applied to your estimated tax
24
If the address shown above is different from that shown on your last return filed with the IRS, would you like us to change it
in our records?
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If line 10, column C, is less than line 20, enter the difference
* If the qualifying person is a child but not your dependent, see page 4 of the instructions.
14
Additional child tax credit from Form 8812
14
1040X
For Paperwork Reduction Act Notice, see page 8 of instructions.
No
Yes
Note. Allow 8-12 weeks to process Form 1040X.
