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                                                          BC-1040X                         

                                AMENDED INDIVIDUAL TAX RETURN                                                                   YEAR

Part I                                                                 Identification and Information
              First name, initial, spouse's name and initial             Last name                                              Social security number

              Present home address (number & street, including apartment)
PLEASE TYPE 
                                                                                                                                Spouse's social security 
OR PRINT
                                                                                                                                number
              City or Town                                                 State                                Zip Code

              IMPORTANT: Please answer all questions, fill in applicable items, and explain changes on pg 2.
Enter name and address on original return. (if same as above write same) If changing from separate to joint return, enter names and addresses 
used on original returns. (Note you cannot change your filing status from joint to separate after the filing date)

              On original Return
Residency     Resident                     Non-resident                          Part-year resident from                      to
Status 
              On this Return
Claimed
              Resident                     Non-resident                          Part-year resident from                      to
                                                   Single Married filing    *Married                 Exemptions:
                                                                    jointly  filing                  On original Return            On This Return
                                                                            separately
Filing Status 
Claimed                   On original Return
                                                                                                     A. As originally    B. Net change                  C. Correct  
                            On this Return                                                           Reported or         (increase or decrease          Amount
              *Give name & SSN of Spouse:
                                                                                                     as last adjusted     explain on pg. 2)
Part II     INCOME, ADDITIONS AND DEDUCTIONS
1 TOTAL W-2 INCOME: (wages, salaries, tips, ect.) (Attach all W-2's)                          
A. Residents: enter total W-2 income.  B. Non-Residents (See Instructions)
2  ADDITIONS TO INCOME  All other income: (interest, dividends, business income, 
capital gains, rents, royalties, partnerships, estates, trusts, etc)

3  SUBTRACTIONS FROM INCOME (All allowed losses and adjustments)
(See instructions)(ATTACH ALL SCHEDULES AND EXPLANATIONS)

4  ADJUSTED INCOME (Add lines 1 and 2 less line 3)

5  EXEMPTIONS: Multiply the number of exemptions claimed by $750.00.

6  TAXABLE INCOME (line 4 less line 5)

7  TAX - Multiply amount on line 6 by one of the following
A RESIDENT - 1% (.01)
B NON-RESIDENT - 1/2% (.005)
Part III     CREDIT AND PAYMENTS
8  Battle Creek tax withheld (Attach W-2 supplied by employer)

9  Estimate payments (including credit from overpayment)

10 Credits for income tax paid to another MI municipality or by a partnership

11 TOTAL PAYMENT AND CREDITS (Add lines 8, 9, and 10)

A  Amount paid with original return, plus additional tax paid after filing                                                                             A

B  Total credits and payments. Add lines 11 and 12 of column C                                                                                         B

Part IV     REFUND OR BALANCEDUE
                                                                                                                                                       C
C Refund, if any shown on original return line 35 or 36

D  Enter the difference between lines B and C (See instructions)                                                                                       D

12 If line 7, column C, is greater than line D, enter BALANCE DUE                                                               PAY IN FULL 12

13 If line 7, Column C, is less than line D, enter REFUND to be received                                                               REFUND 13

Part V       Exemptions            Complete only if a change in exemptions
                                              originally                  B  Net                            C  Corrected 
                                              reported                    Change                                            number
1   Exemptions - yourself and spouse
2   Your dependent children who lived with you
3   Total exemptions (add lines 1 thru 2)
4   Multiply the total number by $750.00 
5  Enter name(s) of your dependent children who lived with you, but were not                                5. Enter 
claimed on original return below. If you need more space please attach list.                                number

                                                     Social Security                                        Number of months 
First Name Last Name                     Relationship
                                                     Number                                                 in your home

Part VI  Explanation of changes to income, deductions, and credits. Enter the line reference from pg 1 
for which you are reporting a change and give the reason for each change. ATTACH APPLICABLE 
SCHEDULES. 

           Instructions for filing the amended return
Lines 1 thru 11 in column A should appear the same as they were last (as originally filed, as corrected by 
Battle Creek or as last amended). Column B should contain only the amount to be added or subtracted 
from that particular line. Column C should contain the correct amount. 

All amounts appearing in column B must be explained on pg 2, part II and must have all supporting 
documentation attached for verification, this includes but is not limited to the following: A copy of the 
Federal 1040X, IRS letter of adjustment, additional and or corrected schedules, forms, worksheets, ect. 

If you need assistance in preparing your Battle Creek return, you may come into our office or call 269-
966-3345. Office hours are 8:00 am to 5 pm, Monday thru Friday. 

Sign Here
                      Taxpayer's signature                   Date        Signature of preparer other than taxpayer      Date

Sign Here

                     Spouse's signature                      Date         Preparers address and phone number

Mail completed return to: City Income Tax Division P O Box 1657, Battle Creek, MI 49016-1657
           (Make checks payable to: City of Battle Creek)