Free Form 1040X (Rev. February 2009) - Federal

(Rev. February 2009)

1040X
Your first name and initial

Form

Department of the Treasury--Internal Revenue Service

Amended U.S. Individual Income Tax Return
See separate instructions.

OMB No. 1545-0074

This return is for calendar year
Please print or type

, or fiscal year ended
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 (no. and street) or P.O. box if mail is not delivered to your home

Apt. no.

Phone number

(
City, town or post office, state, and ZIP code. If you have a foreign address, see page 4 of the instructions.

)

A 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 Yes No in our records? B Filing status. Be sure to complete this line. Note. You cannot change from joint to separate returns after the due date.
On original return Single Married filing jointly Married filing separately Head of household Head of household* Qualifying widow(er) Qualifying widow(er) On this return Single Married filing jointly Married filing separately * If the qualifying person is a child but not your dependent, see page 4 of the instructions.

Use Part II on the back to explain any changes Income and Deductions (see instructions)
1 2 3 4 5 Tax Liability 6 7 8 9 10 11 12 Payments 13 14 15 16 17 18 Adjusted gross income (see page 4) Itemized deductions or standard deduction (see page 4) Subtract line 2 from line 1 Exemptions. If changing, fill in Parts I and II on the back (see page 5) Taxable income. Subtract line 4 from line 3 Tax (see page 5). Method used in col. C Credits (see page 6) Subtract line 7 from line 6. Enter the result but not less than zero Other taxes (see page 6) Total tax. Add lines 8 and 9 1 2 3 4 5 6 7 8 9 10

B. Net change-- A. Original amount or amount of increase as previously adjusted or (decrease)-- (see page 4) explain in Part II

C. Correct amount

Federal income tax withheld and excess social security and 11 tier 1 RRTA tax withheld. If changing, see page 6 Estimated tax payments, including amount applied from prior 12 year's return 13 Earned income credit (EIC) 14 Additional child tax credit from Form 8812 Credits: Recovery rebate; federal telephone excise tax; or from 15 Forms 2439, 4136, 5405, 8885, or 8801 (refundable credit only) Amount paid with request for extension of time to file (see page 6) Amount of tax paid with original return plus additional tax paid after it was filed Total payments. Add lines 11 through 17 in column C

16 17 18

Refund or Amount You Owe
Note. Allow 8-12 weeks to process Form 1040X. 19 20 21 22 23 24 Overpayment, if any, as shown on original return or as previously adjusted by the IRS Subtract line 19 from line 18 (see page 6) Amount you owe. If line 10, column C, is more than line 20, enter the difference and see page 6 If line 10, column C, is less than line 20, enter the difference Amount of line 22 you want refunded to you Amount of line 22 you want applied to your estimated tax 24 19 20 21 22 23

Sign Here
Joint return? See page 4. Keep a copy 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 of which the preparer has any knowledge.

Your signature Preparer's signature Firm's name (or yours if self-employed), address, and ZIP code

Date Date

Spouse's signature. If a joint return, both must sign. Check if self-employed EIN Phone no. ( Cat. No. 11360L ) Form

Date

Paid Preparer's Use Only

Preparer's SSN or PTIN

For Paperwork Reduction Act Notice, see page 8 of instructions.

1040X

(Rev. 2-2009)

Form 1040X (Rev. 2-2009)

Page A. Original number of exemptions reported or as previously adjusted

2

Part I

Exemptions. See Form 1040 or 1040A instructions.

Complete this part only if you are: Increasing or decreasing the number of exemptions claimed on line 6d of the return you are amending, or Increasing or decreasing the exemption amount for housing individuals displaced by Hurricane Katrina or for housing Midwestern displaced individuals. 25 Yourself and spouse
Caution. If someone can claim you as a dependent, you cannot claim an exemption for yourself.

B. Net change

C. Correct number of exemptions

25

26 27 28 29 30

Your dependent children who lived with you Your dependent children who did not live with you due to divorce or separation Other dependents Total number of exemptions. Add lines 25 through 28 Multiply the number of exemptions claimed on line 29 by the amount listed below for the tax year you are amending. Enter the result here.
Tax year
2008 2007 2006 2005

26 27 28 29

Exemption amount
$3,500 3,400 3,300 3,200

But see the instructions for line 4 on page 5 if the amount on line 1 is over:
$119,975 117,300 112,875 109,475

31

If you are claiming an exemption amount for housing individuals displaced by Hurricane Katrina, enter the amount from Form 8914, line 2 for 2005 or line 6 for 2006. If you are claiming an exemption amount for housing Midwestern displaced individuals, enter the amount from the 2008 Form 8914, line 2. (See instructions for line 4). Otherwise enter -0Add lines 30 and 31. Enter the result here and on line 4

30

32 33

31 32
No. of children on 33 who: lived with you did not live with you due to divorce or separation (see page 7) Dependents on 33 not entered above

Dependents (children and other) not claimed on original (or adjusted) return:
(b) Dependent's social security number (a) First name Last name if qualifying (c) Dependent's (d) relationship to you child for child tax credit (see page 7)

Part II

Explanation of Changes
Enter the line number from the front of the form for each item you are changing and give the reason for each change. Attach only the supporting forms and schedules for the items changed. If you do not attach the required information, your Form 1040X may be returned. Be sure to include your name and social security number on any attachments.

If the change relates to a net operating loss carryback or a general business credit carryback, attach the schedule or form that shows the year in which the loss or credit occurred. See pages 2 and 3 of the instructions. Also, check here

Part III Presidential Election Campaign Fund. Checking below will not increase your tax or reduce your refund.
If you did not previously want $3 to go to the fund but now want to, check here If a joint return and your spouse did not previously want $3 to go to the fund but now wants to, check here
Form

1040X

(Rev. 2-2009)