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FORM 104X instRuctiOns
The 2008 Form 104X, Amended Colorado Income Tax Return, is used to                   Leave line 46 blank. Interest will be computed by the Department of
correct your 2008 individual income tax return. For more information or any          Revenue. Interest on any refund created by a loss carryback or an
questions pertaining to income, additions, subtractions, credits, etc., refer        investment tax credit carryback will be paid from the last day of the
to the income tax book for 2008, or call the Department of Revenue at                taxable year in which the loss or credit originated.
(303) 238-SERV (7378). You can also obtain forms and information from
the Internet at www.TaxColorado.com                                                  Attachments. Attach an explanation of the changes to your return and,
                                                                                     if applicable, required attachments (e.g. 104CR, 204). Part-year residents
Complete the first column of Form 104X showing the income, additions,                and nonresidents attach corrected Form 104PN. If this amended return is
subtractions, taxes and credits the way your return was originally filed,            the result of an adjustment made by the Internal Revenue Service attach
as last corrected by yourself on Form 104X, or as last changed by the                a copy of the federal revenue agentโ€™s report with supporting schedules.
Department of Revenue. Complete the second column showing the                        To expedite your refund, attach a copy of the federal record of account to
corrected amounts. Complete the third column showing the net changes                 support any changes to federal taxable income.
with decreases indicated by a โ€œโ€“โ€ minus sign.
                                                                                     Direct Deposit. Complete the direct deposit information if you want
Line 31 computes the amount of credit available on your tax return after             your refund deposited directly into your account at a United States
comparing the tax liabilities to the available credits. Any increase in this         bank or other financial institution.
amount between columns one and two will indicate that a refund is due
on this return. Any decrease in this amount between columns one and                  Foreign Address. If you are entering an address for a foreign country,
two will indicate that a balance is owed back to the state. For example, if          place any postal code at the end of the address line and enter XXXXX
your refund increased from $200 to $250 when you corrected your return,              in the ZIP code box.
column three would indicate the $50 increase on this line. On the other
hand, if your refund decreased from $400 to $140 when you corrected your             Deceased taxpayer. If the taxpayer died since the original return was
return, column three would indicate the $260 difference that you would               filed and you are requesting a refund, attach a copy of Form 102 โ€” Claim
need to repay to the state of Colorado.                                              for Refund Due Deceased Taxpayer and a copy of the death certificate.
                                                                                     Check the deceased box after the decedentโ€™s name.
Line 32 computes the amount owed to the state on your tax return after
comparing the tax liabilities to the available credits. Any decrease in this         A federal net operating loss carried back to a tax year beginning
amount between columns one and two will indicate that a refund is due                on or after January 1, 1987, or carried forward will be allowed for
on this return. Any increase in this amount between columns one and two              Colorado income tax purposes. A nonresident or a part-year resident
will indicate that a balance is owed back to the state. For example, if your         may carry back or forward that portion of his federal net operating loss
balance due increased from $50 to $70 when you corrected your return,                that is from Colorado sources or which relates to the Colorado portion
column three would indicate the $20 you owe to Colorado with this return.            of the year.
On the other hand, if your balance due decreased from $50 to $0 when
you corrected your return, column three would indicate the $50 difference            statute of limitations. The statute of limitations for filing a Colorado
that would be refunded based on this return.                                         claim for refund is generally four years from the original due date of the
                                                                                     return or three years from the date of last payment of tax for the year
AMOunt OWED                                                                          involved, whichever is later. The statute of limitations for claiming a
Line 35 is the total of any decrease indicated in column three of line 31 and        refund that is the result of a loss carry-back or an investment tax credit
any increase indicated in column three of line 32. These amounts reflect             carry-back is four years from the due date of the return for the year in
the additional tax due as a result of this return. (It will not include any tax      which the loss or credit originated. See FYI General 18.
that may still be due based on earlier assessments or on your original
return.) For example, if the overpayment claimed on your original return             Protective claims. If this amended return is being filed to keep the
was $50 and the corrected balance due computed in column two is $90,                 statute of limitations open pending the outcome of a court case or tax
then the total of these changes from lines 30 and 31 will be $140, which             determination in another state that affects your Colorado return, check
is the tax increase that will be reported on this return.                            the protective claim box under reason for filing corrected return.
If you owe additional tax, add interest calculated from the original due date        Change in filing status. If the amended return is being filed to change
of the return on line 36.                                                            the filing status from single or married separate to joint, the taxpayer
                                                                                     that filed the single return must be listed first on the amended return. If
If you have previously been assessed a delinquency penalty or estimated              both taxpayers have filed single, then either taxpayer can be listed first
tax penalty and this amended return causes the amount of penalty to                  and the explanation must specify that one of the original returns was
change, enter the increased penalties on lines 37 and/or 38.                         filed under a different primary Social Security Number (SSN).
REFunD AMOunt                                                                        If the amended return is being filed to change the filing status from
Line 42 is the total of any increase indicated in column three of line 31            joint to single or married separate, the taxpayer whose SSN was
and any decrease indicated in column three of line 32. These amounts                 listed first on the joint return should include all applicable tax data in
reflect the additional refund due as a result of this return. (It will not include   column one of their amended return. The taxpayer whose SSN was
any refund that may still be pending based on your original return.) For             listed second on the joint return should not have any information in
example, if the overpayment claimed on your original return was $50 and              column one and the explanation must specify that the original return
the corrected overpayment computed in column two is $210, then the total             was filed under a different primary SSN.
of these changes from lines 30 and 31 will be $160, which is the refund
claim that will be reported on this return.                                          interest rates on additional amounts due or refunds are as follows:
                                                                                     January 1 through December 31, 2009.
Enter on line 43 any portion of the refund from line 42 that you want                Tax due paid without billing, or paid within 30 days of billing, or on
applied to your 2009 estimated tax rather than having it refunded at this            refunds $5,000 or more and 10% or more of the net tax liability .... 5%
time.                                                                                Tax due paid after 30 days of billing, or on other refunds ................8%
If you have previously been assessed a delinquency penalty or                        Make checks payable to:        Colorado Department of Revenue
estimated tax penalty and this amended return causes the amount of                                                  Denver CO 80261-0005
penalty to change, enter the decreased penalties on lines 44 and/or 45.
cOLORADO DEPARtMEnt OF REvEnuE
                                                                                                   vendor iD
DENVER CO 80261-0005

               2008 FORM 104X
(15)
               AMEnDED cOLORADO inDiviDuAL incOME tAX REtuRn
Reason for amended return (check one):
       Changing residency status               Changing filing status
       Investment credit carryback from tax year ending ______________________________
       Federal net operating loss carryback from tax year ending ______________________
       Federal net capital loss carryback from tax year ending _________________________
       Protective claim, attach explanation               Other, attach explanation
                            LAst nAME                                           FiRst nAME AnD initiAL                        DEcEAsED     sOciAL sEcuRitY nuMBER
Yourself
                                                                                                                                 YEs
Spouse, if joint
                                                                                                                                 YEs
Address                                                                                                                                  Your telephone number
                                                                                                                                         (        )
City                                                                                State         ZIP Code
                                                                                                                                         ROunD tO thE nEAREst DOLLAR

                                                                                                                                cORREct
                                                                                                  ORiginAL AMOunt                                        nEt chAngE
                                                                                                                                                                               โ€“โ€ )
                                                                                                                                                     increase or (decrease โ€œ
                                                                                                                                AMOunt
                                                                                                  or as previously adjusted

 1 Federal taxable income .............................................................. 1                             .00                .00 (01)                              .00

   ADDitiOns tO FEDERAL tAXABLE incOME
                                                                                                                       .00                .00 (02)                              .00
 2 State income tax addback ......................................................... 2
                                                                                                                       .00                .00 (03)                              .00
 3 Other additions, explain: ........................................................... 3
 4 Total of lines 1 through 3 ........................................................... 4                            .00                .00                                   .00

   suBtRActiOns FROM FEDERAL tAXABLE incOME
                                                                                                                       .00                .00 (05)                              .00
  5 State income tax refund ............................................................ 5
                                                                                                                       .00                .00 (06)                              .00
 6 United States government interest ........................................... 6
                                                                                                                       .00                .00 (07)                              .00
 7 Pension-annuity subtraction, taxpayer ...................................... 7
                                                                                                                       .00                .00 (08)                              .00
 8 Pension-annuity subtraction, spouse ........................................ 8
                                                                                                                       .00                .00 (09)                              .00
 9 Colorado source capital gain .................................................... 9
                                                                                                                       .00                .00 (10)                              .00
10 Tuition program contribution ..................................................... 10
                                                                                                                       .00                .00 (11)                              .00
11 Qualifying charitable contribution .............................................. 11
                                                                                                                       .00                .00 (12)                              .00
12 Other subtractions, explain:...................................................... 12
                                                                                                                       .00                .00                                   .00
13 Total of lines 5 through 12 ......................................................... 13
                                                                                                                       .00                .00                                   .00
14 Colorado taxable income, line 4 minus line 13 .........................14
                                                                                                                       .00                .00 (15)                              .00
15 Colorado tax ............................................................................ 15
                                                                                                                       .00                .00 (16)                              .00
16 Alternative minimum tax ...........................................................16
                                                                                                                       .00                .00 (17)                              .00
17 Recapture of prior year credits .................................................17
                                                                                                                       .00                .00                                   .00
18 Total of lines 15 through 17 ....................................................... 18
                                                                                                                       .00                .00 (19)                              .00
19 Personal credits from line 41, Form 104CR ..............................19
                                                                                                                       .00                .00 (20)                              .00
20 Alternative fuel credits from line 44, Form 104CR ....................20
                                                                                                                       .00                .00 (21)                              .00
21 Gross conservation easement credit from line 45, Form 104CR ... 21
                                                                                                                       .00                .00 (22)                              .00
22 Enterprise zone credits from line 17, Form 104CR ...................22
                                                                                                                       .00                .00                                   .00
23 Total of lines 19 through 22 ....................................................... 23
                                                                                                                       .00                .00                                   .00
24 Net tax, line 18 minus line 23 ....................................................24
cORREct
                                                                                                      ORiginAL AMOunt                                                   nEt chAngE
                                                                                                                                                                                              โ€“โ€ )
                                                                                                                                                                    increase or (decrease โ€œ
                                                                                                                                       AMOunt
                                                                                                      or as previously adjusted

                                                                                                                           .00                        .00                                      00
25    Federal Adjusted Gross Income ............................................... 25
                                                                                                                           .00                        .00                                      00
26    Amount from line 24 on front of form (Net Tax) ........................ 26
                                                                                                                           .00                        .00 (27)                                 00
27    Colorado income tax withheld .................................................. 27
                                                                                                                           .00                        .00 (28)                                 00
28    Estimated tax ............................................................................ 28
                                                                                                                           .00                        .00 (29)                                 00
29    Child care credit from line 5 or 6, Form 104CR ........................ 29
                                                                                                                           .00                        .00                                      00
30    Total of lines 27 through 29 ......................................................30
                                                                                                                           .00                        .00                                      00
31    If line 30 exceeds line 26, enter your overpayment .................. 31
                                                                                                                           .00                        .00                                      00
32 If line 26 exceeds line 30, enter the amount owed ................... 32

     cOMPutE thE AMOunt YOu OWE
                                                                                                                                                                                              .00
33    Enter any decrease shown on line 31 column 3 (NET ChANGE)...........................................................33
                                                                                                                                                                                              .00
34    Enter any increase shown on line 32 column 3 (NET ChANGE)............................................................34
                                                                                                                                                                                              .00
35    Additional tax due, total of lines 33 and 34..............................................................................................35
                                                                                                                                                                                              .00
36    Interest due on additional tax โ€” see instructions........................................................... ........................ 36               (36)
                                                                                                                                                                                              .00
37    Penalty due โ€” see instructions........................................................... ................................................... 37       (37)
                                                                                                                                                                                              .00
38    Estimated tax penalty due โ€” see instructions........................................................................................ 38                (38)
                                                                                                                                                                                              .00
39    Payment due with this return, add lines 35 through 38 ........................................................... .............. 39                    (39)
The State may convert your check to a one time electronic banking transaction. Your bank account may be debited as early as the same day received by the State. If converted, your check will not
be returned. If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically.


  cOMPutE YOuR REFunD
                                                                                                                                                                                              .00
40 Enter any increase shown on line 31 column 3 (NET ChANGE)........................................................... 40
                                                                                                                                                                                              .00
41 Enter any decrease shown on line 32 column 3 (NET ChANGE)..........................................................41
                                                                                                                                                                                              .00
42 Refund claimed with this return, total of lines 40 and 41........................................................................42                       (42)
                                                                                                                                                                                              .00
43 Overpayment credited to 2009 estimated tax........................................................................................ 43                     (43)
                                                                                                                                                                                              .00
                                                                                                                                                             (44)
44 Penalty reduced .................................................................................................................................... 44
                                                                                                                                                                                              .00
                                                                                                                                                             (45)
45 Estimated tax penalty reduced .............................................................................................................. 45
46 Interest allowed on refund. To be computed by Department of Revenue .............................................46                                       (46)
47 To be completed by Department of Revenue ........................................................................................47                       (47)
                                                                                                                                                                       Savings
                                                                                                                                         Type:       Checking
                                                                    Routing number

                                                                    Account number
                                                                                                                                    (Name and Telephone Number of                 (Date)
     signED unDER PEnALtY OF PERJuRY in thE sEcOnD DEgREE                                                                         Individual or Firm Preparing Return)
     (Signature of Taxpayer)                                                                          (Date)



     (Signature of Taxpayerโ€™s Spouse, if joint return)                                                (Date)




Attach an explanation of the changes to your return and, if applicable, required attachments (e.g. 104cR, 204). Part-year
residents and nonresidents attach corrected Form 104Pn. if this amended return is the result of an adjustment made by the
internal Revenue service attach a copy of the federal revenue agentโ€™s report with supporting schedules. to expedite your
refund, attach a copy of the federal record of account to support any changes to federal taxable income.

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colorado.gov cms forms dor-tax CY104X

  • 1. FORM 104X instRuctiOns The 2008 Form 104X, Amended Colorado Income Tax Return, is used to Leave line 46 blank. Interest will be computed by the Department of correct your 2008 individual income tax return. For more information or any Revenue. Interest on any refund created by a loss carryback or an questions pertaining to income, additions, subtractions, credits, etc., refer investment tax credit carryback will be paid from the last day of the to the income tax book for 2008, or call the Department of Revenue at taxable year in which the loss or credit originated. (303) 238-SERV (7378). You can also obtain forms and information from the Internet at www.TaxColorado.com Attachments. Attach an explanation of the changes to your return and, if applicable, required attachments (e.g. 104CR, 204). Part-year residents Complete the first column of Form 104X showing the income, additions, and nonresidents attach corrected Form 104PN. If this amended return is subtractions, taxes and credits the way your return was originally filed, the result of an adjustment made by the Internal Revenue Service attach as last corrected by yourself on Form 104X, or as last changed by the a copy of the federal revenue agentโ€™s report with supporting schedules. Department of Revenue. Complete the second column showing the To expedite your refund, attach a copy of the federal record of account to corrected amounts. Complete the third column showing the net changes support any changes to federal taxable income. with decreases indicated by a โ€œโ€“โ€ minus sign. Direct Deposit. Complete the direct deposit information if you want Line 31 computes the amount of credit available on your tax return after your refund deposited directly into your account at a United States comparing the tax liabilities to the available credits. Any increase in this bank or other financial institution. amount between columns one and two will indicate that a refund is due on this return. Any decrease in this amount between columns one and Foreign Address. If you are entering an address for a foreign country, two will indicate that a balance is owed back to the state. For example, if place any postal code at the end of the address line and enter XXXXX your refund increased from $200 to $250 when you corrected your return, in the ZIP code box. column three would indicate the $50 increase on this line. On the other hand, if your refund decreased from $400 to $140 when you corrected your Deceased taxpayer. If the taxpayer died since the original return was return, column three would indicate the $260 difference that you would filed and you are requesting a refund, attach a copy of Form 102 โ€” Claim need to repay to the state of Colorado. for Refund Due Deceased Taxpayer and a copy of the death certificate. Check the deceased box after the decedentโ€™s name. Line 32 computes the amount owed to the state on your tax return after comparing the tax liabilities to the available credits. Any decrease in this A federal net operating loss carried back to a tax year beginning amount between columns one and two will indicate that a refund is due on or after January 1, 1987, or carried forward will be allowed for on this return. Any increase in this amount between columns one and two Colorado income tax purposes. A nonresident or a part-year resident will indicate that a balance is owed back to the state. For example, if your may carry back or forward that portion of his federal net operating loss balance due increased from $50 to $70 when you corrected your return, that is from Colorado sources or which relates to the Colorado portion column three would indicate the $20 you owe to Colorado with this return. of the year. On the other hand, if your balance due decreased from $50 to $0 when you corrected your return, column three would indicate the $50 difference statute of limitations. The statute of limitations for filing a Colorado that would be refunded based on this return. claim for refund is generally four years from the original due date of the return or three years from the date of last payment of tax for the year AMOunt OWED involved, whichever is later. The statute of limitations for claiming a Line 35 is the total of any decrease indicated in column three of line 31 and refund that is the result of a loss carry-back or an investment tax credit any increase indicated in column three of line 32. These amounts reflect carry-back is four years from the due date of the return for the year in the additional tax due as a result of this return. (It will not include any tax which the loss or credit originated. See FYI General 18. that may still be due based on earlier assessments or on your original return.) For example, if the overpayment claimed on your original return Protective claims. If this amended return is being filed to keep the was $50 and the corrected balance due computed in column two is $90, statute of limitations open pending the outcome of a court case or tax then the total of these changes from lines 30 and 31 will be $140, which determination in another state that affects your Colorado return, check is the tax increase that will be reported on this return. the protective claim box under reason for filing corrected return. If you owe additional tax, add interest calculated from the original due date Change in filing status. If the amended return is being filed to change of the return on line 36. the filing status from single or married separate to joint, the taxpayer that filed the single return must be listed first on the amended return. If If you have previously been assessed a delinquency penalty or estimated both taxpayers have filed single, then either taxpayer can be listed first tax penalty and this amended return causes the amount of penalty to and the explanation must specify that one of the original returns was change, enter the increased penalties on lines 37 and/or 38. filed under a different primary Social Security Number (SSN). REFunD AMOunt If the amended return is being filed to change the filing status from Line 42 is the total of any increase indicated in column three of line 31 joint to single or married separate, the taxpayer whose SSN was and any decrease indicated in column three of line 32. These amounts listed first on the joint return should include all applicable tax data in reflect the additional refund due as a result of this return. (It will not include column one of their amended return. The taxpayer whose SSN was any refund that may still be pending based on your original return.) For listed second on the joint return should not have any information in example, if the overpayment claimed on your original return was $50 and column one and the explanation must specify that the original return the corrected overpayment computed in column two is $210, then the total was filed under a different primary SSN. of these changes from lines 30 and 31 will be $160, which is the refund claim that will be reported on this return. interest rates on additional amounts due or refunds are as follows: January 1 through December 31, 2009. Enter on line 43 any portion of the refund from line 42 that you want Tax due paid without billing, or paid within 30 days of billing, or on applied to your 2009 estimated tax rather than having it refunded at this refunds $5,000 or more and 10% or more of the net tax liability .... 5% time. Tax due paid after 30 days of billing, or on other refunds ................8% If you have previously been assessed a delinquency penalty or Make checks payable to: Colorado Department of Revenue estimated tax penalty and this amended return causes the amount of Denver CO 80261-0005 penalty to change, enter the decreased penalties on lines 44 and/or 45.
  • 2. cOLORADO DEPARtMEnt OF REvEnuE vendor iD DENVER CO 80261-0005 2008 FORM 104X (15) AMEnDED cOLORADO inDiviDuAL incOME tAX REtuRn Reason for amended return (check one): Changing residency status Changing filing status Investment credit carryback from tax year ending ______________________________ Federal net operating loss carryback from tax year ending ______________________ Federal net capital loss carryback from tax year ending _________________________ Protective claim, attach explanation Other, attach explanation LAst nAME FiRst nAME AnD initiAL DEcEAsED sOciAL sEcuRitY nuMBER Yourself YEs Spouse, if joint YEs Address Your telephone number ( ) City State ZIP Code ROunD tO thE nEAREst DOLLAR cORREct ORiginAL AMOunt nEt chAngE โ€“โ€ ) increase or (decrease โ€œ AMOunt or as previously adjusted 1 Federal taxable income .............................................................. 1 .00 .00 (01) .00 ADDitiOns tO FEDERAL tAXABLE incOME .00 .00 (02) .00 2 State income tax addback ......................................................... 2 .00 .00 (03) .00 3 Other additions, explain: ........................................................... 3 4 Total of lines 1 through 3 ........................................................... 4 .00 .00 .00 suBtRActiOns FROM FEDERAL tAXABLE incOME .00 .00 (05) .00 5 State income tax refund ............................................................ 5 .00 .00 (06) .00 6 United States government interest ........................................... 6 .00 .00 (07) .00 7 Pension-annuity subtraction, taxpayer ...................................... 7 .00 .00 (08) .00 8 Pension-annuity subtraction, spouse ........................................ 8 .00 .00 (09) .00 9 Colorado source capital gain .................................................... 9 .00 .00 (10) .00 10 Tuition program contribution ..................................................... 10 .00 .00 (11) .00 11 Qualifying charitable contribution .............................................. 11 .00 .00 (12) .00 12 Other subtractions, explain:...................................................... 12 .00 .00 .00 13 Total of lines 5 through 12 ......................................................... 13 .00 .00 .00 14 Colorado taxable income, line 4 minus line 13 .........................14 .00 .00 (15) .00 15 Colorado tax ............................................................................ 15 .00 .00 (16) .00 16 Alternative minimum tax ...........................................................16 .00 .00 (17) .00 17 Recapture of prior year credits .................................................17 .00 .00 .00 18 Total of lines 15 through 17 ....................................................... 18 .00 .00 (19) .00 19 Personal credits from line 41, Form 104CR ..............................19 .00 .00 (20) .00 20 Alternative fuel credits from line 44, Form 104CR ....................20 .00 .00 (21) .00 21 Gross conservation easement credit from line 45, Form 104CR ... 21 .00 .00 (22) .00 22 Enterprise zone credits from line 17, Form 104CR ...................22 .00 .00 .00 23 Total of lines 19 through 22 ....................................................... 23 .00 .00 .00 24 Net tax, line 18 minus line 23 ....................................................24
  • 3. cORREct ORiginAL AMOunt nEt chAngE โ€“โ€ ) increase or (decrease โ€œ AMOunt or as previously adjusted .00 .00 00 25 Federal Adjusted Gross Income ............................................... 25 .00 .00 00 26 Amount from line 24 on front of form (Net Tax) ........................ 26 .00 .00 (27) 00 27 Colorado income tax withheld .................................................. 27 .00 .00 (28) 00 28 Estimated tax ............................................................................ 28 .00 .00 (29) 00 29 Child care credit from line 5 or 6, Form 104CR ........................ 29 .00 .00 00 30 Total of lines 27 through 29 ......................................................30 .00 .00 00 31 If line 30 exceeds line 26, enter your overpayment .................. 31 .00 .00 00 32 If line 26 exceeds line 30, enter the amount owed ................... 32 cOMPutE thE AMOunt YOu OWE .00 33 Enter any decrease shown on line 31 column 3 (NET ChANGE)...........................................................33 .00 34 Enter any increase shown on line 32 column 3 (NET ChANGE)............................................................34 .00 35 Additional tax due, total of lines 33 and 34..............................................................................................35 .00 36 Interest due on additional tax โ€” see instructions........................................................... ........................ 36 (36) .00 37 Penalty due โ€” see instructions........................................................... ................................................... 37 (37) .00 38 Estimated tax penalty due โ€” see instructions........................................................................................ 38 (38) .00 39 Payment due with this return, add lines 35 through 38 ........................................................... .............. 39 (39) The State may convert your check to a one time electronic banking transaction. Your bank account may be debited as early as the same day received by the State. If converted, your check will not be returned. If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically. cOMPutE YOuR REFunD .00 40 Enter any increase shown on line 31 column 3 (NET ChANGE)........................................................... 40 .00 41 Enter any decrease shown on line 32 column 3 (NET ChANGE)..........................................................41 .00 42 Refund claimed with this return, total of lines 40 and 41........................................................................42 (42) .00 43 Overpayment credited to 2009 estimated tax........................................................................................ 43 (43) .00 (44) 44 Penalty reduced .................................................................................................................................... 44 .00 (45) 45 Estimated tax penalty reduced .............................................................................................................. 45 46 Interest allowed on refund. To be computed by Department of Revenue .............................................46 (46) 47 To be completed by Department of Revenue ........................................................................................47 (47) Savings Type: Checking Routing number Account number (Name and Telephone Number of (Date) signED unDER PEnALtY OF PERJuRY in thE sEcOnD DEgREE Individual or Firm Preparing Return) (Signature of Taxpayer) (Date) (Signature of Taxpayerโ€™s Spouse, if joint return) (Date) Attach an explanation of the changes to your return and, if applicable, required attachments (e.g. 104cR, 204). Part-year residents and nonresidents attach corrected Form 104Pn. if this amended return is the result of an adjustment made by the internal Revenue service attach a copy of the federal revenue agentโ€™s report with supporting schedules. to expedite your refund, attach a copy of the federal record of account to support any changes to federal taxable income.