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Amended U.S. Individual Income Tax Return

See separate instructions.

Department of the Treasury—Internal Revenue Service

(Rev. November 2000)

OMB No. 1545-0091

This return is for calendar year

, or fiscal year ended

,

			

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 2 of the instructions.

For Paperwork Reduction Act Notice, see page 6.

A If the name or address shown above is different from that shown on the original return, check here
B Has the original return been changed or audited by the IRS or have you been notified that it will be?

	

Yes

No

C 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 joint return

Married filing separate return

Head of household

Qualifying widow(er)

On this return

Single

Married filing joint return

Married filing separate return

Head of household*

Qualifying widow(er)

* If the qualifying person is a child but not your dependent, see page 2.

Use Part II on the Back to Explain any Changes

Income and Deductions (see pages 2–6)
1 Adjusted gross income (see page 3)

	

2 Itemized deductions or standard deduction (see page 3)
3 Subtract line 2 from line 1

	

1

4 Exemptions. If changing, fill in Parts I and II on the back
5 Taxable income. Subtract line 4 from line 3

	

6 Tax (see page 4). Method used in col. C

7 Credits (see page 4)

	

	

8 Subtract line 7 from line 6. Enter the result but not less than zero
9 Other taxes (see page 4)
10 Total tax. Add lines 8 and 9

	

11 Federal income tax withheld and excess social security and RRTA tax withheld. If changing, see page 5

	

12 Estimated tax payments, including amount applied from prior year’s return

13 Earned income credit (EIC)

14 Additional child tax credit from Form 8812
15 Credits from Form 2439 or Form 4136

	

	

16 Amount paid with request for extension of time to file (see page 5)

	

17 Amount of tax paid with original return plus additional tax paid after it was filed

18 Total payments. Add lines 11 through 17 in column C

	

18

Refund or Amount You Owe

19 Overpayment, if any, as shown on original return or as previously adjusted by the IRS
20 Subtract line 19 from line 18 (see page 5)

	

21 Amount you owe. If line 10, column C, is more than line 20, enter the difference and see page 5

22If line 10, column C, is less than line 20, enter the difference
23 Amount of line 22 you want refunded to you
24 Amount of line 22 you want applied to your

	

	

estimated tax

24

Sign

Here

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.

Joint return?

See page 2.

Your signature

Date

Keep a copy for

your records.

Spouse’s signature. If a joint return, both must sign.

Date

Preparer’s

signature

Date

Check if

self-employed

Preparer’s SSN or PTIN

Paid

Preparer’s

Firm’s name (or

Use Only

yours if self-employed),

address, and ZIP code

Cat. No. 11360L

Form 1040X (Rev. 11-2000)

Your first name and initial

Last name

Your social security number

If a joint return, spouse’s first name and initial

Last name

Spouse’s social security number

()

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A. Original amount or
as previously adjusted
(see page 2)	B. Net change—
amount of increase
or (decrease)—
explain in Part II	C. Correct
amount	

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EIN		
Phone no.	()	

Form 1040X (Rev. 11-2000)

Page 2

Part I

Exemptions. See Form 1040 or 1 040A instructions.

If you are not changing your exemptions, do not complete this part. If claiming more exemptions, complete lines 25–31.
If claiming fewer exemptions, complete lines 25–30.

A. Original

number of

exemptions

reported or as

previously

adjusted

B. Net change

C. Correct

number of

exemptions

25 Yourself and spouse

	

Caution. If your parents (or someone else) can claim you as a dependent

(even if they chose not to), you cannot claim an exemption for yourself.

	

	

	

	

Tax

Exemption

But see the instructions for
line 4 on page 3 if the
amount on line 1 is over:

year

amount

2000

$2,800

$96,700

1999

2,750

94,975

1998

2,700

93,400

1997

2,650

90,900

26 Your dependent children who lived with you

27 Your dependent children who did not live with you due to divorce or separation

28 Other dependents

29 Total number of exemptions. Add lines 25 through 28

30	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 and on line 4.

30

31

Dependents (children and other) not claimed on original (or adjusted) return:
Note. For tax years after 1997, do not complete column (e) below. For tax year 1997, do not complete column (d) below.

No. of your

children on line

31 who:

● lived with

you

● did not live

with you due to

divorce or

separation (see

page 5)

Dependents

on line 31 not

entered above

Part II

Explanation of Changes to Income, Deductions, and Credits

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 page 2 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 1 040X (Rev. 11-2000)

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Last name
(a)	First name	(b) Dependent’s social
security number	(c) Dependent’s relationship to you	(d)if qualifying child for child tax credit (see page 5)	(e) No. of
months lived
in your home	
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