Amended U.S. Individual Income Tax Return: Use Part III On The Back To Explain Any Changes

F
o
r
m
1040X
(Rev. December 2013)
Department of the TreasuryInternal Revenue Service
Amended U.S. Individual Income Tax Return
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, spouses first name and initial Last name Spouses 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 . . . . . . . . . . . . . . .

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 . . . . . . . . . . . . . . . . . . . . .

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 years
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 812 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)
Form 1040X (Rev. 12-2013) Page 2
Part I Exemptions
Complete this part only if you are increasing or decreasing the number of exemptions (personal and dependents) claimed on line 6d of
the return you are amending.
See Form 1040 or Form 1040A instructions and Form 1040X instructions.
A. Original number
of exemptions or
amount reported or
as previously
adjusted
B. Net change
C. Correct
number
or amount
23 Yourself and spouse. Caution. If someone can claim you as a
dependent, you cannot claim an exemption for yourself . . . . . . 23
24 Your dependent children who lived with you . . . . . . . . . 24
25 Your dependent children who did not live with you due to divorce or separation 25
26 Other dependents . . . . . . . . . . . . . . . . . . 26
27 Total number of exemptions. Add lines 23 through 26 . . . . . . 27
28 Multiply the number of exemptions claimed on line 27 by the exemption
amount shown in the instructions for line 28 for the year you are
amending. Enter the result here and on line 4 on page 1 of this form. . 28
29 List ALL dependents (children and others) claimed on this amended return. If more than 4 dependents, see instructions.
(a) First name Last name
(b) Dependents social
security number
(c) Dependents
relationship to you
(d) Check box if qualifying
child for child tax credit (see
instructions)
Part II Presidential Election Campaign Fund
Checking below will not increase your tax or reduce your refund.
Check here if you did not previously want $3 to go to the fund, but now do.
Check here if this is a joint return and your spouse did not previously want $3 to go to the fund, but now does.
Part III Explanation of changes. In the space provided below, tell us why you are filing Form 1040X.
Attach any supporting documents and new or changed forms and schedules.
Sign Here
Remember to keep a copy of this form 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 about which the preparer has any knowledge.
Your signature Date
Spouses signature. If a joint return, both must sign. Date

Paid Preparer Use Only
Preparers signature Date Firms name (or yours if self-employed)

Print/type preparer's name Firm's address and ZIP code
PTIN
Check if self-employed
Phone number EIN
For forms and publications, visit IRS.gov. Form 1040X (Rev. 12-2013)

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Information about Form 1040X and its separate instructions is at www.irs.gov/form1040x.

Your signature Date

Spouses signature. If a joint return, both must sign. Date

Preparers signature Date Firms name (or yours if self-employed)

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