Fillable Printable Form 1040X (Rev. February 2009)

Form 1040X (Rev. February 2009)

Department of the Treasury—Internal Revenue Service

OMB No. 1545-0074

Amended U.S. Individual Income Tax Return

Form

(Rev. February 2009)

See separate instructions.

This return is for calendar year

, or fiscal year ended

, .

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.

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

Qualifying widow(er)

Head of household*

Married filing separately

Married filing jointly

Single

On this return

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

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)

Tax Liability

Total tax. Add lines 8 and 9

Federal income tax withheld and excess social security and

tier 1 RRTA tax withheld. If changing, see page 6

Estimated tax payments, including amount applied from prior

year’s return

Earned income credit (EIC)

Credits: Recovery rebate; federal telephone excise tax; or from

Forms 2439, 4136, 5405, 8885, or 8801 (refundable credit only)

Amount paid with request for extension of time to file (see page 6)

Payments

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

Refund or Amount You Owe

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

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. ( )

Cat. No. 11360L

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

Amount of line 22 you want refunded to you

Amount of line 22 you want applied to your estimated tax

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?

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.

Additional child tax credit from Form 8812

1040X

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

Yes

Note. Allow 8-12 weeks to process Form 1040X.

Page 2

Form 1040X (Rev. 2-2009)

Exemptions. See Form 1040 or 1040A instructions.

A. Original

number of

exemptions

reported or as

previously

adjusted

Complete this part only if you are:

C. Correct

number of

exemptions

B. Net change

Yourself and spouse

Caution. If someone can claim you as a dependent, you cannot claim an

exemption for yourself.

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

No. of children

on 33 who:

Dependents (children and other) not claimed on original (or adjusted) return:

(b) Dependent’s social

security number

relationship to you

(a)

● did not live

with you due to

divorce or

separation (see

page 7)

Dependents

on 33 not

entered above

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

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

Part III

Part I

Part II

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

Exemption

amount

But see the instructions for

line 4 on page 5 if the

amount on line 1 is over:

Last name

First name

● lived with

you

2008

2007

2006

2005

$3,500

3,400

3,300

3,200

$119,975

117,300

112,875

109,475

(d) if qualifying

child for child tax

credit (see page 7)

Form 1040X (Rev. 2-2009)

● 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.

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 -0-

Add lines 30 and 31. Enter the result here and on line 4