Department of the Treasury—Internal Revenue Service

Department of the Treasury—Internal Revenue Service g 1040X LL (Rev. January 20 I 9) ► Go to wwwirs.gov/Fortn1O40X for instructions and the latest information. This return is for calendar year O 2018 O 2017 O 2016 O 2015 Other year. Enter one: calendar year or fiscal year (month and year ended): Your first name and initial Amended U.S. Individual Income Tax Return OMB No. 154S-0074 Last name Your social security number If a joint retum. spouse's first name and initial Last name Spouse's social security number Current home address (number and street). If you have a M. box. see instructions. Apt. no. Your phone number City, town or post office. state, and ZIP code. If you have a foragn address. also complete spaces below. See instructions. Foreign county name Foreign province/state/county Amended return filing status. You must check one box even if you are not changing your filing status. Caution: In general, you can't change your filing status from a joint return to separate returns after the due date. O Single O Married filing jointty O Married filing separately O Qualifying widow(en O 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 /1. Original amount mooned or as previously adjusted (see instructions) B. Net change— amount of increase or (decrease)— explain in Pan III C. Correct amount Income and Deductions 1 Adjusted gross income. If a net operating loss (NOL) carryback is included, check here P O 2 Itemized deductions or standard deduction 3 Subtract line 2 from line 1 4a Exemptions (amended returns for years before 2018 only). If changing, complete Part I on page 2 and enter the amount from line 29 . . . . b Qualified business income deduction (2018 amended returns only) . . 5 Taxable income. Subtract line 4a or 4b from line 3. If the result is zero or less, enter -0- 1 2 3 4a 4b 5 Tax Liability 6 Tax. Enter method(s) used to figure tax (see instructions): 7 Credits. If a general business credit caffyback is included, check here P O 8 Subtract line 7 from line 6. If the result is zero or less, enter -0- . . 9 Health care: individual responsibility (see instructions) 10 Other taxes 11 Total tax. Add lines 8, 9, and 10 6 7 8 9 10 11 Payments 12 Federal income tax withheld and excess social security and tier 1 RRTA tax withheld. (If changing, see instructions.) 13 Estimated tax payments, including amount applied from prior year's return 14 Earned income credit (EIC) 15 Refundable credits from: OSchedule 8812 Form(s) O 2439 12 13 14 15 04136 08863 O sus s 8962 a Dottier (specify): 16 Total amount paid with request for extension of time to file, tax paid with tax paid after return was filed 17 Total payments. Add lines 12 through 15, column C, and line 16 original return, and additional 16 17 Refund or Amount You Owe 18 Overpayment, if any, as shown on original retum or as previously adjusted by the IRS 19 Subtract line 18 from line 17. (If less than zero, see instructions.) 20 Amount you owe. If line 11, column C, is more than line 19, enter the difference 21 If line 11, column C, is less than line 19, enter the difference. This is the amount overpaid on this return 22 Amount of line 21 you want refunded to you 23 Amount of line 21 you want applied to your (enter year): estimated tax . . . 1231 18 19 20 21 22 I Foreign postal code K Full-year health care coverage (or, for 2018 amended returns only, exempt). See inst. Complete and sign this form on page 2. For Paperwork Reduction Act Notice, see Instructions. Font 1040A (Rev. 1-2019( EFTA01222575 Font.' 1040X (Rev. 1-2019) Page 2 P r I Exemptions Complete this part only if any information relating to exemptions (to dependents if amending your 2018 return) has changed from what you reported on the return you are amending. This would include a change in the number of exemptions (of dependents if amending our 2018 return). For 2018 amended returns only, leave lines 24, 28, and 29 blank. Fill in all other applicable lines. Note: See the Form 1040 or, for amended returns for years before 2018, the Form 1040A instructions. See also the Form 1040X instructions. A. Original number of exemptions or amount reported or as pnaviously adjusted B. Net change C. Correct number or amount 24 25 26 27 28 29 Yourself and spouse. Caution: If someone can claim you as a dependent, you can't claim an exemption for yourself. If amending your 2018 return, leave line blank Your dependent children who lived with you Your dependent children who didn't live with you due to divorce or separation Other dependents Total number of exemptions. Add lines 24 through 27. If amending your 2018 return, leave line blank Multiply the number of exemptions claimed on line 28 by the exemption amount shown in the instructions for line 29 for the year you are amending. Enter the result here and on line 4a on page 1 of this form. If amending your 2018 return, leave line blank 24 25 26 27 28 29 30 List ALL dependents (children and others claimed on this amended retum. If more than 4 dependents, see inst. and /here Ir U Dependents (see instructions): (a) First name Last name (b) Social security number (e) ReIatIonsNp to you (d) iiif qualifies for (see Instructions): Child tax credit Credit for other dependents (2018 amended returns only) 0 0 • • 0 0 O O brag Presidential Election Campaign Fund Checking below won't increase your tax or reduce your refund. 0 Check here if you didn't previously want $3 to go to the fund, but now do. 0 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. P Attach any supporting documents and new or changed forms and schedules. 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. conect. and complete. Declaration of preparer (other than taxpayer) is based on all information about which the preparer has any knowledge. Sign Here Your signature Date Yak oocupabon Spouse's signature. If a joint return, both must sign. Date Spouse's occupation Paid Preparer Use Only Preparers signature Date Firm's name (or yours if self-employed) Print/type preparers name Arms adckess and ZIP code 0 Check if serf-employed PTIN Phone number EIN For toms and publications. visit www.irs.gov. Form 1040X (Rev. 1-2019) EFTA01222576