Form PIT-X Amended Personal Income Tax Return

(You must complete both lines 16 and 16a or the deduction will be denied ) 12a Check the box if you itemized You must also complete line 7 if applicable 12a "F" if FIRST YEAR RES "P" if PART YEAR RES 4b SSN (From federal Form 1040 line 38; Form 1040A line 22 or Form 1040EZ line 4 ) (If filing jointly BOTH must sign even if only one had income ) *120160200* *120170200* 16a Unreimbursed and uncompensated medical care expenses 18a 18 1d 1e 2012 PIT X (page 2) 2012 PIT X NEW MEXICO PERSONAL INCOME TAX 2a 2d 4a Name 9 FEDERAL ADJUSTED GROSS INCOME Additional amount for tax on lump sum distributions (See PIT 1 instructions) Additions to federal income (Line 5 of PIT ADJ; attach PIT ADJ) Amended returns may be electronically filed through the Department's web site AS PREVIOUSLY FILED AS AMENDED Attach schedules even if they did not change from the previously filed return check the box and enter the extension date Check this box if the address is new or changed 4 other than the taxpayer or spouse named on this return enter the for each taxpayer Enter name and SSN of that person "R" if RESIDENT; You must also attach Form RPD 41083 "N" if NON RESIDENT; Continue on the next page Credit for taxes paid to another state You must have been a New Mexico resident during all or part of the year (See PIT 1 instructions Include a copy of other state's return ) Deductions/Exemptions from federal income (Line 21 of PIT ADJ; attach PIT ADJ) EXEMPTIONS Number of Qualified Exemptions EXTENSION OF TIME TO FILE F 1 F 2 Federal exemption amount (From federal Form 1040 line 42; Form 1040A Federal standard or itemized deduction amount (From federal Form 1040 line 40; Form 1040A line 24; or Form 1040EZ line 5 ) For the year January 1 December 31 2012 or fiscal year beginning ending I declare I have examined this return including accompanying schedules and statements and to the best of my knowledge and belief it is true correct and complete If a deceased taxpayer's refund must be made payable to a person3a If from the Rate Table enter "R" If from line 14 of PIT B enter "B" If submitting this return by mail send to: If you are a dependent of another taxpayer enter 00 If you have a federal or state extension If you itemized your federal deduction amount enter the amount of state and local tax deduction claimed on line 5 federal Form 1040 Schedule A line 26; or leave blank if you filed Form 1040EZ ) Medical care expense deduction (See PIT 1 instructions ) NET NEW MEXICO INCOME TAX (Add lines 18 and 19 then subtract lines 20 and 21) (Cannot be less than zero ) New Mexico low and middle income tax exemption (See PIT 1 instructions ) NEW MEXICO PERSONAL INCOME TAX AMENDED RETURN NEW MEXICO TAXABLE INCOME (Add lines 9 10 and 11 then subtract lines 12 13 14 15 and 16) (Cannot be less than zero ) Non refundable credits from Schedule PIT CR (Line 21 of PIT CR; attach PIT CR) P O Box 25122 Santa Fe New Mexico 87504 5122 Print your name (first middle last) 1b 1c Print your spouse's name (first middle last) Include spouse if married filing separately 2b 2c Reason for amending: NM Taxation and Revenue Department Residency If taxpayer or spouse diedSOCIAL SECURITY NUMBER Blind Over 65 status before this return is filed Enter date of death Residency status: Complete Spouse's signature Date Tax on amount on line 17 Taxpayer's E mail address Taxpayer's phone number Your signature Date YOUR SOCIAL SECURITY NUMBER