Department of the Treasury—Internal Revenue Service
1040-X
Form                                   Amended U.S. Individual Income Tax Return                                                           OMB No. 1545-0074
                                                        ▶ Use this revision to amend 2019 or later tax returns.
(Rev. July 2021)                       ▶ Go to www.irs.gov/Form1040X for instructions and the latest information.
This return is for calendar year (enter year)                     or fiscal year (enter month and year ended)
Your first name and middle initial                                         Last name                                              Your social security number 

If joint return, spouse’s first name and middle initial                    Last name                                              Spouse’s social security number 

Current 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 can’t 
change your filing status from married filing jointly to married filing separately after the return due date. 
     Single      Married filing jointly                 Married filing separately (MFS)      Head of household (HOH)                Qualifying widow(er) (QW)
If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying 
person is a child but not your dependent ▶
Enter on lines 1 through 23, columns A through C, the amounts for the return                       A. Original amount             B. Net change—
year entered above.                                                                                          reported or as     amount of increase   C. Correct     
                                                                                                   previously adjusted            or (decrease)—     amount 
Use Part III on page 2 to explain any changes.                                                     (see instructions)             explain in Part III
Income and Deductions                                                                                                                                       
1      Adjusted  gross  income  .       If  a  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 
4a     Reserved for future use  .           .  .        . . . . . .        . . .    .   .  . .   4a
     b Qualified business income deduction  .               . . . .        . . .    .   .  . .   4b
5      Taxable income. Subtract line 4b from line 3. If the result is zero or less, 
       enter -0-  .  . .           . . .    .  .        . . . . . .        . . .    .   .  . .   5 
Tax Liability                                                                                                                                               
6      Tax. Enter method(s) used to figure tax (see instructions):
                                                                                                 6 
7      Nonrefundable credits. If a 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      Reserved for future use  .           .  .        . . . . . .        . . .    .   .  . .   9
10     Other taxes .   .           . . .    .  .        . . . . . .        . . .    .   .  . .   10
11     Total tax. Add lines 8 and 10           .        . . . . . .        . . .    .   .  . .   11
Payments                                                                                                                                                    
12     Federal income tax withheld and excess social security and tier 1 RRTA 
       tax withheld. (If changing, see instructions.)  .          .        . . .    .   .  . .   12
13     Estimated tax payments, including amount applied from prior year’s return                 13
14     Earned income credit (EIC)  .           .        . . . . . .        . . .    .   .  . .   14
15     Refundable credits from:          Schedule 8812 Form(s)               2439         4136
            8863     8885              8962 or            other (specify):                       15
16     Total amount paid with request for extension of time to file, tax paid with original return, and additional 
       tax paid after return was filed         .        . . . . . .        . . .    .   .  . . . . .         . .            . . . . .      16 
17     Total payments. Add lines 12 through 15, column C, and line 16 .                    . . . . .         . .            . . . . .      17 
Refund or Amount You Owe 
18     Overpayment, if any, as shown on original return or as previously adjusted by the IRS                                . . . . .      18 
19     Subtract line 18 from line 17. (If less than zero, see instructions.)               . . . . .         . .            . . . . .      19 
20     Amount you owe. If line 11, column C, is more than line 19, enter the difference  .                     .            . . . . .      20 
21     If line 11, column C, is less than line 19, enter the difference. This is the amount overpaid on this return                        21 
22     Amount of line 21 you want refunded to you               . .        . . .    .   .  . . . . .         . .            . . . . .      22 
23     Amount of line 21 you want applied to your (enter year):                            estimated tax       23 
                                                                                                                              Complete and sign this form on page 2.
For Paperwork Reduction Act Notice, see separate instructions.                               Cat. No. 11360L                          Form 1040-X (Rev. 7-2021)

Form 1040-X (Rev. 7-2021)                                                                                                                     Page 2 
Part I       Dependents
Complete this part to change any information relating to your dependents.                          A. Original number  B. Net change —    C. Correct 
                                                                                                   reported or as 
This would include a change in the number of dependents.                                           of dependents       amount of increase number   
Enter the information for the return year entered at the top of page 1.                            previously adjusted or (decrease)
24      Reserved for future use  .    .    . . .     .     .   .    . .    . .   .  . .   .    24
25      Your dependent children who lived with you  .               . .    . .   .  . .   .    25
26      Your  dependent  children  who  didn’t  live  with  you  due  to  divorce  or 
        separation  .     . .     . . .    . . .     .     .   .    . .    . .   .  . .   .    26
27      Other dependents  .       . . .    . . .     .     .   .    . .    . .   .  . .   .    27
28      Reserved for future use  .    .    . . .     .     .   .    . .    . .   .  . .   .    28
29      Reserved for future use  .    .    . . .     .     .   .    . .    . .   .  . .   .    29
30      List ALL dependents (children and others) claimed on this amended return.
Dependents (see instructions):                                                                                 (d) ✓ if qualifies for (see instructions):
                                                                      (b) Social security     (c) Relationship 
If more         (a) First name                            Last name        number                  to you         Child tax credit        Credit for other  
than four                                                                                                                                 dependents
dependents, 
see 
instructions 
and check 
here ▶
Part II      Presidential Election Campaign Fund (for the return year entered at the top of page 1)
Checking below won’t increase your tax or reduce your refund.
     Check here if you didn’t 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 1040-X.                      
        ▶ 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, correct, 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                     Your occupation
                ▲

                    Spouse’s signature. If a joint return, both must sign.                    Date                     Spouse’s occupation
Paid                                                                                                                   Check          if  PTIN
                Print/Type preparer’s name                     Preparer’s signature                       Date
                                                                                                                       self-employed 
Preparer     Firm’s name     ▶                                                                                         Firm’s EIN ▶
Use Only     Firm’s address ▶                                                                                          Phone no. 
For forms and publications, visit www.irs.gov/Forms.                                                                   Form 1040-X (Rev. 7-2021)