Fillable Form 1045 2019 Application for Tentative Refund

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Form 1045 2019 Application for Tentative Refund

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Form 1045
Department of the Treasury
Internal Revenue Service
Application for Tentative Refund
▶
For individuals, estates, or trusts.
▶
Mail in separate envelope. (Don’t attach to tax return.)
▶
Go to www.irs.gov/Form1045 for the latest information.
OMB No. 1545-0098
2019
Type or print
Name(s) shown on return
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 province/county Foreign postal code
1
This application is
filed to carry back:
a Net operating loss (NOL) (Sch. A, line 25)
$
b Unused general business credit
$
c Net section 1256 contracts loss
$
2 a For the calendar year 2019, or other tax year
beginning , 2019, and ending , 20
b Date tax return was filed
3
If this application is for an unused credit created by another carryback, enter year of first carryback
▶
4
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
▶
5
If SSN for carryback year is different from above, enter
a SSN
▶
and b Year(s)
▶
6
If you changed your accounting period, give date permission to change was granted
▶
7 Have you filed a petition in Tax Court for the year(s) to which the carryback is to be applied? . . . . . Yes No
8
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
9
If you are carrying back an NOL or a 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
Computation of Decrease in Tax
(see instructions)
preceding
tax year ended
▶
preceding
tax year ended
▶
preceding
tax year ended
▶
Note: If 1a and 1c are blank, skip lines 10 through 15.
Before
carryback
After
carryback
Before
carryback
After
carryback
Before
carryback
After
carryback
10
NOL deduction after carryback (see instructions)
11 Adjusted gross income . . . . .
12 Deductions (see instructions) . . .
13 Subtract line 12 from line 11 . . .
14 Exemptions (see instructions) . . .
15 Taxable income. Line 13 minus line 14
16
Income tax. See instructions and attach
an explanation . . . . . . . .
17
Excess advance premium tax credit
repayment (see instructions) . . . .
18 Alternative minimum tax . . . . .
19
Add lines 16 through 18 . . . . .
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 10670A
Form 1045 (2019)
Form 1045 (2019)
Page 2
Computation of Decrease in Tax
(continued)
preceding
tax year ended
▶
preceding
tax year ended
▶
preceding
tax year ended
▶
Before
carryback
After
carryback
Before
carryback
After
carryback
Before
carryback
After
carryback
20
General business credit (see instructions)
21
Net premium tax credit (see instructions)
22 Other credits. Identify . . . . . .
23 Total credits. Add lines 20 through 22
24
Subtract line 23 from line 19 . . . .
25 Self-employment tax (see instructions)
26
Additional Medicare Tax (see instructions)
27
Net Investment Income Tax (see
instructions) . . . . . . . . .
28
Health care: individual responsibility
(see instructions) . . . . . . .
29 Other taxes . . . . . . . . .
30 Total tax. Add lines 24 through 29 . .
31
Enter the amount from the “After carryback”
column on line 30 for each year . . . .
32 Decrease in tax. Line 30 minus line 31
33 Overpayment of tax due to a claim of right adjustment under section 1341(b)(1) (attach computation) . . .
Sign
Here
Keep a copy of
this application
for your records.
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
▲
Spouse’s signature. If Form 1045 is filed jointly, both must sign. Date
Paid
Preparer
Use Only
Print/Type preparer’s name Preparer’s signature Date
Check if
self-employed
PTIN
Firm’s name
▶
Firm’s EIN
▶
Firm’s address
▶
Phone no.
Form 1045 (2019)
Form 1045 (2019)
Page 3
Schedule A—NOL (see instructions)
1
For individuals, subtract your standard deduction or itemized deductions from your adjusted gross
income and enter it here. For estates and trusts, enter taxable income increased by the total of the
charitable deduction, income distribution deduction, and exemption amount (see instructions)
. . 1
2 Nonbusiness capital losses before limitation. Enter as a positive number
(see instructions) . . . . . . . . . . . . . . . . . . .
2
3 Nonbusiness capital gains (without regard to any section 1202 exclusion) 3
4 If line 2 is more than line 3, enter the difference. Otherwise, enter -0- . . 4
5 If line 3 is more than line 2, enter the difference.
Otherwise, enter -0- . . . . . . . . .
5
6 Nonbusiness deductions (see instructions) . . . . . . . . . . . 6
7 Nonbusiness income other than capital gains (see
instructions) . . . . . . . . . . . .
7
8 Add lines 5 and 7 . . . . . . . . . . . . . . . . . . . 8
9 If line 6 is more than line 8, enter the difference. Otherwise, enter -0- . . . . . . . . . . 9
10
If line 8 is more than line 6, enter the difference.
Otherwise, enter -0-. But don’t enter more than
line 5 . . . . . . . . . . . . . .
10
11 Business capital losses before limitation. Enter as a positive number . . 11
12 Business capital gains (without regard to any
section 1202 exclusion) . . . . . . . .
12
13 Add lines 10 and 12 . . . . . . . . . . . . . . . . . . 13
14 Subtract line 13 from line 11. If zero or less, enter -0- . . . . . . . 14
15 Add lines 4 and 14 . . . . . . . . . . . . . . . . . . . 15
16
Enter the loss, if any, from line 16 of your 2019 Schedule D (Form 1040 or
1040-SR). (For estates and trusts, enter the loss, if any, from line 19,
column (3), of Schedule D (Form 1041).) Enter as a positive number. If you
don’t have a loss on that line (and don’t have a section 1202 exclusion),
skip lines 16 through 21 and enter on line 22 the amount from line 15 . .
16
17 Section 1202 exclusion. Enter as a positive number (see instructions) . . . . . . . . . . 17
18 Subtract line 17 from line 16. If zero or less, enter -0- . . . . . . . 18
19
Enter the loss, if any, from line 21 of your 2019 Schedule D (Form 1040 or
1040-SR). (For estates and trusts, enter the loss, if any, from line 20 of
Schedule D (Form 1041).) Enter as a positive number . . . . . . .
19
20 If line 18 is more than line 19, enter the difference. Otherwise, enter -0- . 20
21 If line 19 is more than line 18, enter the difference. Otherwise, enter -0- . . . . . . . . . 21
22 Subtract line 20 from line 15. If zero or less, enter -0- . . . . . . . . . . . . . . . 22
23 Domestic production activities deduction from your 2019 return (see instructions) . . . . . . 23
24 NOL deduction for losses from other years. Enter as a positive number . . . . . . . . . 24
25 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 don’t have an NOL . . . . . . . . . .
25
Form 1045 (2019)
Form 1045 (2019)
Page 4
Schedule B—NOL Carryover (see instructions)
Complete one column before going to
the next column. Start with the earliest
carryback year.
preceding
tax year ended
▶
preceding
tax year ended
▶
preceding
tax year ended
▶
1 NOL deduction. Enter as a positive
number . . . . . . . . . .
2
Taxable income before 2019 NOL
carryback (see instructions). For estates
and trusts, increase this amount by the
sum of the charitable deduction and
income distribution deduction (see
instructions) . . . . . . . . .
3 Net capital loss deduction (see
instructions) . . . . . . . . .
4 Section 1202 exclusion. Enter as a
positive number (see instructions) . .
5 Domestic production activities
deduction (see instructions) . . . .
6 Adjustment to adjusted gross income
(see instructions) . . . . . . .
7 Adjustment to itemized deductions
(see instructions) . . . . . . .
8
For individuals, enter deduction for
exemptions. For estates and trusts,
enter exemption amount . . . . .
9
Modified taxable income. Combine
lines 2 through 8. If zero or less, enter
-0- (see instructions) . . . . . .
10 NOL carryover (see instructions) . .
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.
11 Adjusted gross income before 2019
NOL carryback . . . . . . . .
12 Add lines 3 through 6 above . . .
13 Modified adjusted gross income. Add
lines 11 and 12 . . . . . . . .
14 Medical expenses from Sch. A (Form
1040), line 4, or as previously adjusted
15 Medical expenses from Sch. A (Form
1040), line 1, or as previously adjusted
16 Multiply line 13 by percentage from
Sch. A (Form 1040), line 3 . . . .
17 Subtract line 16 from line 15. If zero or
less, enter -0- . . . . . . . .
18 Subtract line 17 from line 14 . . . .
19
Mortgage insurance premiums from
Sch. A (Form 1040), line 13, or as
previously adjusted . . . . . . .
20 Refigured mortgage insurance
premiums (see instructions) . . . .
21 Subtract line 20 from line 19 . . .
Form 1045 (2019)
Form 1045 (2019)
Page 5
Schedule B—NOL Carryover (continued)
Complete one column before going to
the next column. Start with the earliest
carryback year.
preceding
tax year ended
▶
preceding
tax year ended
▶
preceding
tax year ended
▶
22 Modified adjusted gross income from
line 13 on page 4 of the form . . .
23
Enter as a positive number any NOL
carryback from a year before 2019 that
was deducted to figure line 11 on page
4 of the form . . . . . . . . .
24 Add lines 22 and 23 . . . . . .
25
Charitable contributions from Sch. A
(Form 1040), line 14 (line 19 for years
before 2018), or Sch. A (Form 1040NR),
line 5, or as previously adjusted . . .
26 Refigured charitable contributions (see
instructions) . . . . . . . . .
27 Subtract line 26 from line 25 . . .
28 Casualty and theft losses from Form
4684, line 18 . . . . . . . . .
29 Casualty and theft losses from Form
4684, line 16 . . . . . . . . .
30 Multiply line 22 by 10% (0.10) . . .
31 Subtract line 30 from line 29. If zero or
less, enter -0- . . . . . . . .
32 Subtract line 31 from line 28 . . .
33
Miscellaneous itemized deductions
(for years before 2018) from Sch. A
(Form 1040), line 27, or Sch. A (Form
1040NR), line 13, or as previously
adjusted . . . . . . . . . .
34
Miscellaneous itemized deductions
(for years before 2018) from Sch. A
(Form 1040), line 24, or Sch. A (Form
1040NR), line 10, or as previously
adjusted . . . . . . . . . .
35 Multiply line 22 by 2% (0.02) . . .
36 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 in the
instructions. Otherwise, combine lines
18, 21, 27, 32, and 37; enter the result
here and on line 7 (page 4) . . . .
Form 1045 (2019)
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Form 1045 2019 Application for Tentative Refund

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Completed 16 March 2020

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