State of Rhode Island Division of Taxation 
 Form RI-1040, RI-1040NR or RI-1041 
 Supplement to Individual Income Tax Return                    IMAGEONLY

 Name(s) shown on Form RI-1040, RI-1040NR or RI-1041           Your social security number

EXPLANATION OF CHANGES TO INCOME, DEDUCTIONS AND CREDITS
Enter the line number from the form for each item which you are changing and give the reason for each change. If you do not attach the 
required information, your Amended Return may not be approved. 
 
Be sure to include all schedules and forms that were part of your original return and not just those that are being adjusted.  A complete 
return is needed for timely processing.