Refund orAmountYouOwe Payments Tax Liability Income andDeductions Use PartIIIonpage2toexplainanychanges. year enteredabove. Enter onlines1through23,columnsAC,theamountsforreturn person isachildbutnotyourdependent If youcheckedtheMFSbox,enternameofyourspouse.HOHorQWchild’sifqualifying change yourfilingstatusfrommarriedjointlytoseparatelyafterthereturnduedate. Amended returnfilingstatus.YoumustcheckoneboxevenifyouarenotchangingyourCaution:Ingeneral,can’t Foreign countryname City, townorpostoffice,state,andZIPcode.Ifyouhaveaforeignaddress,alsocompletespacesbelow.Seeinstructions. Current homeaddress(numberandstreet).IfyouhaveaP.O.box,seeinstructions. If jointreturn,spouse’sfirstnameandmiddleinitial Your firstnameandmiddleinitial This returnisforcalendaryear(enteryear) (Rev. July2021) For Paperwork Reduction ActNotice,seeseparate instructions. 15 14 13 12 11 10 23 22 21 20 19 18 17 16 Form 9 8 7 6 5 3 2 1 4a 1040-X Single b

Amount ofline 21 youwantappliedtoyour Refundable creditsfrom: Earned incomecredit(EIC) Estimated taxpayments,includingamountappliedfromprior year’sreturn Federal Total tax.Addlines8and10 Other taxes Reserved forfutureuse Subtract line7from6.Iftheresultiszeroorless,enter-0- included, checkhere Nonrefundable credits.Ifageneralbusinesscreditcarrybackis Tax. Entermethod(s)usedtofiguretax(seeinstructions): enter -0- Taxable Qualified businessincomededuction Reserved forfutureuse Subtract line2from1 Itemized deductionsorstandarddeduction Adjusted Amount ofline21youwantrefundedto If line11,columnC,islessthan line19,enterthedifference.Thisisamount Amount youowe.Ifline11,columnC,ismorethan line19,enterthedifference Subtract line18from17. (If lessthanzero,seeinstructions.) Overpayment, ifany,asshown onoriginalreturnoraspreviouslyadjustedbytheIRS Total payments.Addlines12through15,columnC,andline 16 Total tax paidafterreturnwasfiled tax withheld.(Ifchanging,seeinstructions.) included, checkhere 8863 amount income Married filingjointly income. gross . 8885 . . paid tax . . income. Subtract with . . withheld . . . . request ▶ 8962 or ...... Amended U.S.IndividualIncomeTaxReturn Gotowww.irs.gov/Form1040Xforinstructionsandthelatestinformation. If line Schedule 8812 ...... a and 4b net ...... for

Married filingseparately(MFS) excess ▶ from ▶ ...... extension operating Usethisrevisiontoamend2019orlatertaxreturns. other (specify): ...... Department oftheTreasury—InternalRevenueService line ...... social 3. (enter year): ...... Form(s) If of loss ...... the security time or fiscalyear(entermonthandended) ...... result (NOL) ...... Last name Last name to ...... and 2439 file, Foreign province/state/county is ...... carryback zero tier tax ...... 1 or paid ...... RRTA

▶ 4136 ▶ less, ...... estimated tax Head ofhousehold(HOH) with is ...... Cat. No.11360L . . . . original 4b 4a 15 14 13 12 11 10 9 8 7 6 5 3 2 1 . . . . A. Originalamount . . . . previously adjusted Apt. no. overpaid onthisreturn (see instructions) reported oras return, ...... 23

...... and Complete andsign thisformonpage2...... additional ...... amount ofincrease Your phonenumber Spouse’s socialsecuritynumber Your socialsecuritynumber B. Netchange— explain inPartIII or (decrease)— ...... Foreign postalcode Qualifying widow(er)(QW)

Form

22 21 20 19 18 17 16 1040-X OMB No.1545-0074 C. Correct amount (Rev.7-2021)

Form 1040-X (Rev. 7-2021) Page 2 Part I Dependents A. Original number Complete this part to change any information relating to your dependents. B. Net change — of dependents C. Correct amount of increase This would include a change in the number of dependents. reported or as number or (decrease) Enter the information for the return year entered at the top of page 1. previously adjusted 24 Reserved for future use ...... 24 25 Your dependent children who lived with you ...... 25 26 Your dependent children who didn’t live with you due to divorce or separation ...... 26 27 Other dependents ...... 27 28 Reserved for future use ...... 28 29 Reserved for future use ...... 29 30 List ALL dependents (children and others) claimed on this amended return. Dependents (see instructions): (d) ✓ if qualifies for (see instructions): (b) Social security (c) Relationship Credit for other If more number to you Child tax credit (a) First name Last name dependents than four dependents, see instructions and check here ▶ Part II Presidential Election Campaign Fund (for the return year entered at the top of page 1) Checking below won’t increase your tax or reduce your refund. Check here if you didn’t previously want $3 to go to the fund, but now do. Check here if this is a joint return and your spouse did not previously want $3 to go to the fund, but now does. Part III Explanation of Changes. In the space provided below, tell us why you are filing Form 1040-X. ▶ Attach any supporting documents and new or changed forms and schedules.

Remember to keep a copy of this form for your records. Under penalties of perjury, I declare that I have filed an original return, and that I have examined this amended return, including accompanying schedules and statements, and to the best of my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information about which the preparer has any knowledge.

Sign ▲

Here Your signature Date Your occupation ▲

Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation Print/Type preparer’s name PTIN Paid Preparer’s signature Date Check if self-employed Preparer Firm’s name ▶ Firm’s EIN ▶ Use Only Firm’s address ▶ Phone no. For forms and publications, visit www.irs.gov/Forms. Form 1040-X (Rev. 7-2021)