Form 1045 Application for Tentative Refund 2010
Summary: This is an example of Form 1045 (2010) with items included
as described in the text. Additionally, these line items are completed:
-
Name(s) shown on return
field contains Martha Sanders -
Number, street, and apartment or suite number. If a P.O. box,
see page 4 of the instructions.
field contains 9876 Holly Street -
City, town or post office, state, and ZIP code. If a foreign
address, see page 4 of the instructions.
field contains Yardley, Pennsylvania 19067 -
Social security or employer identification number
field contains 123-00-4567 -
Daytime phone number
field contains (041) 123-4567 -
2b. Date tax return was filed
field contains 3-5-2011 -
7. Have you filed a petition in Tax Court for the year(s) to
which the carryback is to be applied? No
checkbox checked -
8. Is any part of the decrease in tax due to a loss or credit
from a tax shelter required to be registered? No
checkbox checked -
9. If you are carrying back an NOL. or net section 1256 contracts
loss, did this cause the release of foreign tax credits or the release of other
credits due to the release of the foreign tax credit? See page 3 of the
instructions. No
checkbox checked - Under
Computation of Decrease in Tax: 2nd preceding tax year ended
12-31-08
: -
-
13. Subtract line 12 from line 11
-
-
Before carryback
field contains 36,750 -
After carryback
field contains 26,000
-
14. Exemptions. See page 6 of the instructions
-
-
Before carryback
field contains 3,500 -
After carryback
field contains 3,500
-
15. Taxable income. Line 13 minus line 14
-
-
Before carryback
field contains 33,250 -
After carryback
field contains 22,500
-
16. Income tax. See page 6 of the instructions and attach
an explanation
-
-
Before carryback
field contains 4,633 -
After carryback
field contains 2,978
-
18. Add lines 16 and 17
-
-
Before carryback
field contains 4,633 -
After carryback
field contains 2,978
-
22. Subtract line 21 from line 18
-
-
Before carryback
field contains 4,633 -
After carryback
field contains 2,978
-
25. Total tax. Add lines 22 through 24
-
-
Before carryback
field contains 10,753 -
After carryback
field contains 9,098
-
26. Enter the amount from the After carryback column on line
25 for each year
field contains 9,098 -
27. Decrease in tax. Line 25 minus line 26
field contains 1,655
- Under
Sign Here
: -
-
Your signature
field contains Martha Sanders -
Date
field contains 4-12-2011
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