Case File
efta-efta01222582DOJ Data Set 9OtherF.. 1045
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta01222582
Pages
5
Persons
0
Integrity
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Text extracted via OCR from the original document. May contain errors from the scanning process.
F.. 1045
Department of the Treasury
Internal Revenue Service
Application for Tentative Refund
dividuals,
No.1545-
a
Iii. For In
states, or trus .
P Mail In separate envelope .(Don't attach to tax return.)
le Go to www.lts.gov/Forrn1045 for the latest Information.
OMB
2018
ti
.c a
°
Name(s) shown on return
Social security or employer Identification number
Number. street. and apt. or site no. If a P.O. box. see instructions.
Spouse's social security number (SSN)
City. town or post office, state, end ZIP code. If a foreign address. also complete spaces below (see instructions).
Daytime phone number
Foreign country name
Foreign province/county
Foreign postal code
1
ThIs application is
filed to carry back:
a Net operating loss (NOL) (Sch. A. line 25)
$
b Unused general business credit
$
c Net section 1256 contracts loss
$
2a For the calendar year 2018, or other tax year
beginning
.2018, and ending
. 20
b Date tax return was filed
3
If this application is for an unused credit created by another carryback, enter year of first carryback ►
4
If you filed a joint return (or separate return) for some, but not all, of the tax years involved in figuring the carryback. list the
years and specify whether joint (J) or separate (S) return for each ►
5
If SSN for canyback year is different from above, enter
a SSN ►
and b Year(s) OP.
6
If you changed your accounting period, give date permission to change was granted ►
7
Have you filed a petition in Tax Court for the year(s) to which the carryback is to be applied?
0 Yes 0 No
8
is any part of the decrease in tax due to a loss or credit resulting from a reportable transaction required to be
disclosed on Form 8886, Reportable Transaction Disclosure Statement?
0 Yes 0 No
9
If you are carrying back an NOL or net section 1256 contracts loss, did this cause the release of foreign tax
0 Yes El No
credits or the release of other credits due to the release of the foreign tax credit (see instructions)? . . .
Computation of Decrease in Tax
(See instructions)
Note: If 1a and 1c are blank, skip lines 10 through 15.
preceding
lo•
preceding
Iii•
preceding
So
tax year ended
tax year ended
tax year ended
Before
carryback
After
canyback
Before
carryback
After
canyback
Before
carryback
After
caryback
10
11
12
13
14
15
16
17
18
19
NOL deduction after canyback (see instructions)
Adjusted gross income
Deductions (see instructions)
Subtract line 12 from line 11
.
.
.
Exemptions (see instructions) . . .
Taxable income. Line 13 minus line 14
Income tax. See instructions and attach
an explanation
Excess advance premium tax credit
repayment (see instructions). . .
Alternative minimum tax
Add lines 16 through 18
III
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
Form 104.5 (2018)
EFTA01222582
Form 1045 (2018)
Page 2
Computation of Decrease in Tax
(continued)
preceding
►
preceding
►
preceding
►
tax year ended
tax yeas ended
tax year ended
Before
canybadc
Mier
canyback
Before
canybaok
After
carryback
Before
carryback
After
carryback
20
21
22
23
24
25
26
27
28
29
30
31
32
General business credit (see instructions)
Net premium tax credit (see instructions)
Other credits. Identify
Total credits. Add lines 20 through 22
Subtract line 23 from line 19 . . . .
Self-employment tax (see instructions)
Additional Medicare Tax (see instructions)
Net Investment Income Tax (see
instructions)
Health care: individual responsibility
(see instructions)
Other taxes
Total tax. Add lines 24 through 29 .
Enter the amount from the "After carryback"
column on line 30 for each year . . . .
Decrease in tax. Line 30 minus line 31
_
33
Overpayment of tax due to a claim of right adjustment under section 1341(b)(1) (attach computation)
. . .
Sign
Here
Keep a copy of
this application
to your records.
Under penalties of penury. I declare that I have exammed this application and accompanying schedules and statements. and to the best of my knowledge
and bebef, they are true. correct. and complete.
Your signature
Date
Spouse's signature. if Form 1045138W jointly, both must sign.
Date
Paid
Preparer
Use Only
Print/Type preparers name
Preparers signature
Date
Check
self-employed
PTIN
Firm's name P.
Ann's EIN ►
Firm's address ►
Phone no.
Form 1045 (201%
EFTA01222583
Form 1045 (2018)
Page 3
Schedule A—NOL (see instructions)
1
For individuals, subtract your standard deduction or itemized deductions from your adjusted gross
income and enter it here. For estates and trusts, enter taxable income increased by the total of the
charitable deduction, income distribution deduction, and exemption amount see instructions)
2
Nonbusiness capital losses before limitation. Enter as a positive number
2
3
Nonbusiness capital gains (without regard to any section 1202 exclusion)
3
4
If line 2 is more than line 3, enter the difference. Otherwise, enter -0- . .
4
5
If line 3 is more than line 2, enter the difference.
5 I
Otherwise, enter -0-
6
Nonbusiness deductions (see instructions)
6
7
Nonbusiness income other than capital gains (see
instructions)
7
8
Add lines 5 and 7
8
9
If line 6 is more than line 8, enter the difference. Otherwise, enter -0-
10
If line 8 is more than line 6. enter the difference.
Otherwise, enter -0-. But don't enter more than
line 5
10
11
Business capital losses before limitation. Enter as a
sitive number .
11
section 1202 exclusion)
12 I
12
Business capital gains (without regard to any
13
Add lines 10 and 12
13
14
Subtract line 13 from line 11. If zero or less, enter -0
14
15
Add lines 4 and 14
15
16
Enter the loss, if any, from line 16 of your 2018 Schedule D (Form 1040).
(For estates and trusts, enter the loss, if any, from line 19, column (3), of
Schedule D (Form 1041).) Enter as a positive number. If you don't have a
loss on that line (and don't have a section 1202 exclusion), skip lines 16
through 21 and enter on line 22 the amount from line 15
76
17
Section 1202 exclusion. Enter as a positive number
18
Subtract line 17 from line 16. If zero or less, enter -0-
18
19
Enter the loss, if any, from line 21 of your 2018 Schedule D (Form 1040).
(For estates and trusts, enter the loss, if any, from line 20 of Schedule D
(Form 1041).) Enter as a positive number
19
20
If line 18 is more than line 19, enter the difference. Otherwise, enter -0-
20
21
If line 19 is more than line 18, enter the difference. Otherwise, enter -0-
22
Subtract line 20 from line 15. If zero or less, enter -0-
23
Domestic production activities deduction from your 2018 return. See instructions
24
NOL deduction for losses from other years. Enter as a positive number
25
NOL Combine lines 1, 9, 17, and 21 through 24. If the result is less than zero, enter it here and on
page 1, line 1a. If the result is zero or more, you don't have an NOL
9
17
21
22
23
24
25
Form 1045 poi Eq
EFTA01222584
Fonn 1045(2018)
Page 4
Schedule B—NOL Carryover (see instructions)
Complete one column before going to
the next column. Start with the earliest
carryback year.
preceding
1
NOL deduction
(see instructions).
Enter as a positive number . . .
2
Taxable income before 2018 NOL
carryback (see instructions). For estates
and trusts, increase this amount by the
sum of the charitable deduction and
income distribution deduction . .
3
Net
capital
loss
deduction
(see
instructions)
4
Section 1202 exclusion. Enter as a
positive number
5
Domestic
production
activities
deduction
6
Adjustment to adjusted gross income
(see instructions)
7
Adjustment to itemized deductions
(see instructions)
8
For individuals, enter deduction for
exemptions (minus any amount on
Form 8914. line 2 for 2008: line 6 for
2009). For estates and trusts, enter
exemption amount
9
Modified taxable income. Combine
lines 2 through 8. If zero or less, enter
10
NOL carryover (see instructions) . .
Adjustment to Itemized Deductions
(Individuals Only) Complete lines 11
through 38 for the carryback year(s) for
which you itemized deductions only if
line 3, 4. or 5 above is more than zero
11
Adjusted gross income before 2018
NOL carryback
12
Add lines 3 through 6 above
. .
13
Modified adjusted gross income. Add
lines 11 and 12
14
Medical expenses from Sch. A (Form
1040). line 4 (or as previously adjusted)
15
Medical expenses from Sch. A (Form
1040). line 1 (or as previously adjusted)
16
Multiply line 13 by percentage from
Sch. A (Form 1040). line 3 . . . .
17
Subtract line 16 from line 15. If zero or
less, enter -0-
18
Subtract line 17 from line 14. . .
19
Mortgage insurance premiums from
Sch. A (Form 1040). line 13 (or as
previously adjusted)
20
Refigured
mortgage
insurance
premiums (see instructions) . . .
21
Subtract line 20 from line 19
. .
preceding
tax year ended ►
1
precedele
tax year end.
►
I
Form 1045 (201%
EFTA01222585
Fenn 1045 (2018)
Page 5
Schedule B—NOL Carryover (continued)
Complete one column before going to
the next column. Start with the earliest
canyback year.
preceding
preceding
►
preceding
►
tax year ended ►
tax year ended
tax year ended
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
Modified adjusted gross income from
line 13 on page 4 of the form
. .
Enter as a positive number any NOL
carryback from a year before 2018 that
was deducted to figure line 11 on page
4 of the tom)
Add lines 22 and 23
Charitable contributions from Sch. A
(Form 1040), line 19, or Sch. A (Form
1040NR), line 5 (line 7 for 2008 through
2010), or as previously adjusted
.
Refigured charitable contributions (see
instructions)
Subtract line 26 from line 25
. .
Casualty and theft losses from Form
4684, line 18 (line 23 for 2008; line 21
for 2009; line 20 for 2010)
. . . .
Casualty and theft losses from Form
4684, line 16 (line 21 for 2008; line 19
for 2009; line 18 for 2010)
. . . .
Multiply line 22 by 10% (0.10) . . .
Subtract line 30 from line 29. If zero or
less, enter -0-
Subtract line 31 from line 28
. . .
Miscellaneous
itemized
deductions
from Sch. A (Form 1040), line 27, or
Sch. A (Form 1040NR), line 13 (line 15
for 2008 through 2010), or as previously
adjusted
Miscellaneous
itemized
deductions
from Sch. A (Form 1040), line 24, or
Sch. A (Form 1040NR), line 10 (line 12
for 2008 through 2010), or as previously
adjusted
Multiply line 22 by 2% (0.02)
. .
Subtract line 35 from line 34. If zero or
less, enter -0-
Subtract line 36 from line 33
. . .
Complete
the
worksheet
in
the
instructions if line 22 is more than the
applicable
amount
shown
in
the
instructions. Otherwise, combine lines
18, 21, 27, 32, and 37; enter the result
here and on line 7 (page 4) . . . .
Form 1045 (2018)
EFTA01222586
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