Form IT-201-X (2012) Amended Resident Income Tax Return (long form), Description of Form IT-201-X

00 13 Farm income or loss (submit a copy of federal Schedule F Form 1040) 14 Unemployment compensation 15 Taxable amount of social security benefits (also enter on line 27) 00 79 Subtract line 78 from line 77 23 00 24 00 31 00 32 00 45 00 Head of household (with qualifying person) 10 500 Identifying number Married filing joint return 15 000 Married filing separate return 7 500 Principal business activity Qualifying widow(er) with dependent child 15 000 Single and you marked item C No 7 500 Single and you marked item C Yes $ 3 000 Your social security number (1) Number of months you lived in NYC in 2012 (2) Enter the number of days spent in NYC in 2012Off (2) Number of months your spouselived in NYC in 2012 (add lines 14 and 15; enter on line 34 above) (any part of a day spent in NYC is considered a day) (continued on page 4) (enter spouse s social security number above) (enter spouse s social security number above) quarters in NYC during 2012? Yes (Explain) (from the front page) (enter on line 34 above) (mark an (or as adjusted by the Tax Department; see instructions) 1 Medical and dental expenses (federal Sch A line 4) 1 Wages salaries tips etc 10 00 10 Taxable amount of pensions and annuities If received as a beneficiary mark an X in the box Off 11 00 11 Rental real estate royalties partnerships S corporations trusts etc (submit copy of federal Schedule E Form 1040) 12 00 12 Rental real estate included in line 11 13 00 14 00 15 00 16 Other income 17 Add lines 1 through 11 and 13 through 16 18 Total federal adjustments to income 19 Federal adjusted gross income (subtract line 18 from line 17) 19 IT 201 X (2012) Page 3 of 6 2 Taxable interest income 2 Taxes you paid (federal Sch A line 9) 20 Interest21 Public 22 New Y 20 00 23 Other 26 00 27 00 28 00 29 00 3 Interest you paid (federal Sch A line 15) 3 Ordinary dividends 30 00 31 Other 32 Add lines 25 through 31 34 00 34 Enter your standard deduction (from table below) or your itemized deduction (from schedule below) Mark an X in the appropriate box: 35 00 36 000 00 37 00 38 00 39 00 4 Gifts to charity (federal Sch A line 19) 4 Taxable refunds credits or offsets of state and local income taxes (also enter on line 25) 40 00 40 NYS household credit 41 00 41 Resident credit 42 00 42 Other NYS nonrefundable credits (Form IT 201 ATT line 7) 43 00 43 Add lines 40 41 and 42 44 00 44 Subtract line 43 from line 39 (if line 43 is more than line 39 leave blank) 45 Net other NYS taxes (Form IT 201 ATT line 30) 46 00 46 Total New York State taxes (add lines 44 and 45) 47 00 47 NYC resident tax on line 38 amount 48 00 48 NYC household credit 49 00 49 Subtract line 48 from line 47 (if line 48 is more than 5 Alimony received 5 Casualty and theft losses (federal Sch A line 20) 50 00 50 Part year NYC resident tax (Form IT 360 1) 51 00 51 Other NYC taxes (Form IT 201 ATT line 34) 52 00 52 Add lines 49 50 and 51 53 00 53 NYC nonrefundable credits (Form IT 201 ATT line 10) 54 00 54 Subtract line 53 from line 52 (if line 53 is more than 55 00 56 00 57 00 58 00 59 Sales or use tax as reported on your original return (see instructions Do not leave line 59 blank ) 6 Business income or loss (submit a copy of federal Schedule C or C EZ Form 1040) 6 Job expenses / misc deductions (federal Sch A line 27) 60 Total voluntary contributions as reported on your original return (or as adjusted by the Tax Department; see instructions) 60a 00 60a Return a Gift to Wildlife 60b 00 60b Missing/Exploited Children Fund 60c 00 60c Breast Cancer Research Fund 60d 00 60d Alzheimer s Fund 60e 00 60e Olympic Fund 60f 00 60f Prostate Cancer Research Fund 60g 00 60g 9/11 Memorial 60h 00 60h Volunteer Firefighting & EMS Recruitment Fund 61 Total New York State New York City and Yonkers taxes sales or use tax and voluntary contributions (add lines 46 58 59 and 60) 62 Enter amount from line 61 63 Empire State child credit 64 NYS/NYC child and dependent care credit 65 NYS earned income credit (EIC) 66 NYS noncustodial parent EIC 67 Real property tax credit 68 College tuition credit 69 NYC school tax credit (also complete F on page 1) 7 Capital gain or loss (if required submit a copy of federal Schedule D Form 1040) 7 Other misc deductions (federal Sch A line 28) 70 NYC earned income credit 71 Other refundable credits (Form IT 201 ATT line 18) 72 Total New York State tax withheld 73 Total New York City tax withheld 74 Total Yonkers tax withheld 75 Total estimated tax payments / Amount paid with Form IT 370 76 Amount paid with original return plus additional tax paid 77 Total payments (add lines 63 through 76) 78 Overpayment if any as shown on original return or previously adjusted by NY State (see instr ) 78a Amount from original Form IT 201 line 79 (see instructions) 8 Enter amount from federal Schedule A line 29 8 Other gains or losses (submit a copy of federal Form 4797) 80 If line 79 is more than line 62 subtract line 62 from line 79 and indicate how you want your refund direct 81 If line 79 is less than line 62 subtract line 79 from line 62 (see instructions) 82 Account information for direct deposit (see instructions) 82a Account type: 82c Account number 83 Reason(s) for amending your return (mark an X in all applicable boxes; see instructions) 83a Federal audit change (complete lines 84 through 91 below) 83b Worthless stock/securities 83c Claim of right 83d Wages 83e Military 83f Court ruling 83g Workers compensation 83h Treaties/visa 83i Tax shelter transaction 83j Credit claim 83k Protective claim (see instructions) OffOffOffOff 83l Net operating loss (see instructions) Mark an X in the box 83m Other Mark an X in the box 83n To report adjustments to partnership or S corporation income gain loss or deduction provide the following information: 84 Enter the date (mm dd yyyy) of the 85 Do you concede the federal audit final federal determination 86 List federal changes 86a 00 86b 00 86c 00 86d 00 86e 00 87 00 87 Net federal changes (increase or decrease) 88 Federal taxable income (mark an X in one box) Per return 88 00 89 00 89 Corrected federal taxable income 9 State local and foreign income taxes (or general sales tax 9 Taxable amount of IRA distributions If received as a beneficiary mark an X in the box 90 Federal credits disallowed Earned income credit 91 Federal penalties assessed OffOff 91a Fraud 91b Negligence 91c Other (explain below) A Filing Address of partnership or S corporation after your original return was filed (see instructions) Amended Resident Income Tax Return Amount disallowed Off Amount you owe and ending See the instructions Form IT 201 X I for help completing your amended return and enter the year of the loss and explain: B Did you itemize your deductions on your 2012 federal income tax return? Yes box): Business checking or Business savings 82b Routing number C Can you be claimed as a dependent on another taxpayer s federal return? Yes No card or changes? (If No explain below ) Yes check Child care credit D Did you file an amended federal debit deposit (fill in line 82) or Direct deposit efunds credits or offsets of state and local income taxes (from line 4)25 Taxable r26 Pensions of NYS and local governments and the federal government 27 Taxable amount of social security benefits (from line 15) 28 Interest income on U S government bonds 29 Pension and annuity income exclusion 30 New York s 529 college savings program deduction/earnings 25 00 employee 414(h) retirement contributions from your wage and tax statements ork s 529 college savings program distributions 22 00 F NYC residents and NYC part year Filing status Standard deduction First name and middle initial Last name Relationship Social security number Date of birth (mm dd yyyy) For the full year January 1 2012 through December 31 2012 or fiscal year beginning G Enter your 2 character special condition codeOff H Dependent exemption information Head of household (with qualifying person) Identify: if applicable (see instructions) If applicable also enter your second 2 character Off if applicable) and other subtraction adjustments 10 Subtract line 9 from line 8 11 Addition adjustments 12 Add lines 10 and 11 13 Itemized deduction adjustment 14 Subtract line 13 from line 12 15 College tuition itemized deduction (see Form IT 272) 16 New York State itemized deduction If more than 9 dependents mark an X in the box If you marked an X in box 83a above you must complete lines 84 through 91 below All others may skip lines 84 through 91 and go directly to the Third party designee question You must sign your amended return below income on state and local bonds and obligations (but not those of NYS or its local governments) 21 00 IT 201 X IT 201 X (2012) Page 5 of 6 Itemized 35 Subtract line 34 from line 33 (if line 34 is more than line 33 leave blank) 36 Dependent exemptions 37 Taxable income (subtract line 36 from line 35) line 47 leave blank) line 52 leave blank) 55 Yonkers resident income tax surcharge 56 Yonkers nonresident earnings tax (Form Y 203) 57 Part year Yonkers resident income tax surcharge (Form IT 360 1) Mark one refund choice: Married filing joint return E (1) Did you or your spouse maintain living Married filing separate return Name of partnership or S corporation Name(s) as shown on page 1 New York State Department of Taxation and Finance New York State New York City Yonkers New York State New York State itemized deduction schedule Note: If the funds for your refund would go to an account outside the U S mark an X in this box (see instructions) Off OffOff OffOff OffOffOff OffOffOff ork adjusted gross income (subtract line 32 from line 24) 33 New Y 33 00 Page 2 of 6 IT 201 X (2012) Your social security number Page 4 of 6 IT 201 X (2012) Your social security number Page 6 of 6 IT 201 X (2012) Your social security number paper Partnership Personal checking or Personal savings or Previously adjusted OffOff Qualifying widow(er) with dependent child residents only: return? (see instructions) Yes S corporation See Important information in the instructions See instructions for where to mail your return Single special condition code standard deduction table Standard or status Whole dollars only X in one