Form
1040X
(Rev. December 2013)
Department of the Treasury—Internal Revenue Service
Amended U.S. Individual Income Tax Return
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Information about Form 1040X and its separate instructions is at www.irs.gov/form1040x.
OMB No. 1545-0074
This return is for calendar year
2013 2012 2011 2010
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
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 cannot change your filing status from joint 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.)
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
Payments
Tax Liability
1 Adjusted gross income. If net operating loss (NOL) carryback is
included, check here . . . . . . . . . . . . . . .
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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 28 . . . . . . . . . . . . . . . . .
4
5 Taxable income. Subtract line 4 from line 3 . . . . . . . . . . 5
6
Tax. Enter method used to figure tax (see instructions):
6
7 Credits. If general business credit carryback is included, check
here . . . . . . . . . . . . . . . . . . . . .
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7
8 Subtract line 7 from line 6. If the result is zero or less, enter -0- . . . 8
9 Other taxes . . . . . . . . . . . . . . . . . . . . 9
10 Total tax. Add lines 8 and 9 . . . . . . . . . . . . . . . 10
11 Federal income tax withheld and excess social security and tier 1 RRTA
tax withheld (if changing, see instructions) . . . . . . . . . .
11
12 Estimated tax payments, including amount applied from prior year’s
return . . . . . . . . . . . . . . . . . . . . . .
12
13 Earned income credit (EIC) . . . . . . . . . . . . . . . 13
14
Refundable credits from Schedule(s)
8812 or M or Form(s) 2439
4136 5405 8801 8812 (2010 or 2011) 8839 8863
8885 or other (specify):
14
15 Total amount paid with request for extension of time to file, tax paid with original return, and additional
tax paid after return was filed . . . . . . . . . . . . . . . . . . . . . . . .
15
16 Total payments. Add lines 11 through 15 . . . . . . . . . . . . . . . . . . . . 16
Refund or Amount You Owe (Note. Allow 8–12 weeks to process Form 1040X.)
17
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) . . . . . . . . . . . . . 18
19
Amount you owe. If line 10, column C, is more than line 18, enter the difference . . . . . . . .
19
20 If line 10, column C, is less than line 18, enter the difference. This is the amount overpaid on this return 20
21 Amount of line 20 you want refunded to you . . . . . . . . . . . . . . . . . . . 21
22
Amount of line 20 you want applied to your
estimated tax .
(enter year): 22
Complete and sign this form on Page 2.
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11360L
Form
1040X (Rev. 12-2013)
