Form Bc-1040 X - Amended Individual Income Tax Return Page 2
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1
2PART I
EXEMPTIONS
A. Number
C. Corrected
originally
B. Net change
number
reported
1.
Exemptions - yourself and spouse, 65 or over, blind ............................................................ 1.
2.
Your dependent children who lived with you ............................................................... 2.
3.
Other dependents ............................................................................................................. 3.
4.
Total exemptions (add lines 1 through 3) .............................................................................. 4.
5.
Multiply applicable exemption amount by the total number of exemptions claimed ................. 5.
6.
Enter first names of your dependent children who lived with you, but were not claimed on original return
Enter number
7.
Other dependents not claimed on original return:
(d) Did dependent
(c) Number
(e) Did you provide
have income
of months
more than one-half
lived in your
of $1,500 or
of dependent's
(b) Relationship
(a) Name
more?
home
support?
Enter number
PART II
Explanation of Changes to Income, Deductions, and Credits
Enter the line reference from page 1 for which you are reporting a change
and give the reason for each change. Attach applicable schedules
(INSTRUCTIONS FOR FILING AMENDED RETURN)
The taxpayer information at the top of the return should appear the same as the original return was filed. If any of the original information
was changed, that portion should have a circle placed around it and the corrected information should be written in Part II (above).
Lines 1 through 13A, in Column A should appear the same as they were on your original City Tax Return BC-1040. Column B should only
contain the amounts to be added or subtracted from the particular corresponding line. Column C should contain the corrected result after all
changes have been calculated, and should appear as you wish to amend your return for the tax year in question.
All amounts appearing in Column B must be explained on page 2 part II, and must have all supporting documentation attached for
verification.
If you wish to have assistance in preparing your Battle Creek City returns you can come into our office, Room 114, first floor in City Hall
(10 N. Division St.); or you may call 966-3345 on Monday through Friday from 8:00 am to 5:00 pm.
SIGN HERE _____________________________________
_____________________________________________
(Taxpayer's signature and date)
(Signature of prepayer other than taxpayer and date)
SIGN HERE _____________________________________
_____________________________________________
(Spouse's signature and date)
(Address)
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