19CAMENP 9/27/18
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Student Name: _____________________________________________________________
Last Name First Name MI
HCC Student ID: ______________________________
For an individual who filed an amended Internal Revenue Service (IRS) income tax return for 2017, please
submit the following:
A 2017 IRS Tax Return Transcript (that will only include information from the original tax return), or a
2017 signed IRS Tax Return, or any other IRS tax transcript(s) that include all of the income and tax
information required to be verified; and
A signed copy of the 2017 IRS Form 1040X, “Amended U.S. Individual Income Tax Return,” that was
filed with the IRS.
Please write which parent amended their tax return:
• Parent(s): ______________________________
Student Signature: _______________________________________ Date: _______________
Parent Signature: _______________________________________ Date: _______________
(Required for Dependent Students)
Office Use Only: IRS DRT CODE SHOWS “07”. Yes_____ or No ___ Initials ______
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
Amended Tax Return
Form for Parent(s)
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
Phone: 240-500-2473
finaid@hagerstowncc.edu
FAX: 301-791-9165
