Amended Nebraska Individual Income Tax Return FORM 1040XN 2019
PRINTRESETAmended Nebraska Individual Income Tax ReturnTaxable Year of Original Return, 2019 and endingPlease Type or PrintbeginningYour First Name and InitialLast NameIf a Joint Return, Spouse’s First Name and InitialLast Name,FORM 1040XN2019Please Do Not Write In This SpaceCurrent Mailing Address (Number and Street or PO Box)CityState(1)Farmer/Rancher(2)Active Military(3)Zip CodeSpouse’s Social Security NumberDeceased Taxpayers (First Names and Dates of Death)Are you filing this amended return because:a. The Nebraska Department of Revenue hasnotified you that your return will be audited?YESNOb. The Internal Revenue Service has correctedYESyour federal return?If Yes, identify office:Attach a copy of changes from the Internal Revenue Service.NO1Your Social Security NumberFEDERAL FILING STATUS (check only one for each return):Original Amended(1) Single(2) Married, filing jointly(3) Married, filing separatelySpouse’s SSN:(4) Head of household(5) Widow(er) with dependent child(ren)Are you filing for a refund based on:a. The filing of a federal amended return or claim for refund?YESAttach copies of Federal Form 1045 or 1040X and supporting schedules.b. Carryback of a net operating loss or IRC § 1256 loss?If Yes, year of loss:Amount: NOYESNOAttach copies of Federal Form 1045 or 1040X with supporting schedules, and a completedNebraska NOL Worksheet.2CHECK IF (on federal return):Original Amended(1) You were 65 or over(2) You were blind(3) Spouse was 65 or over(4) Spouse was blind(5) You or your spouse can be claimedas a dependent on anotherperson’s return3TYPE OF RETURN FILED(check only one for each return):Original Amended(1) Resident(2) Partial-yearresidentfrom / /to / /(3) Nonresident4 Nebraska personal exemptions. (Enter 1 in each line of 4a or 4b that applies):a Yourself. If someone can claim you as a dependent, leave blank. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ab Spouse. Married filing jointly returns, if someone can claim your spouse as a dependent leave blank. . . . . . . 4 bcDependents, if more than three, see instructionsDependent'sFirst NameLast NameSocial Security NumberTotal number ofdependents listed. . . . 4 cTotal Nebraska personal exemptions – add lines 4a, 4b, and 4c. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Correct AmountComputation of Tax567894Federal adjusted gross income (AGI). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Nebraska standard deduction (see Form 1040N instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Total itemized deductions (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .State and local income taxes (line 5a, Schedule A, Federal Form 1040 or 1040-SR - see instructions). . . . . .Nebraska itemized deductions (line 7 minus line 8). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5678910 Nebraska deduction (larger of line 6 or line 9). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1011 Nebraska income before adjustments (line 5 minus line 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1112 Adjustments increasing federal AGI (line 1, Nebraska Schedule I, Form 1040XN) . . . . . . . . . . . . . . . . . . . . . .1213 Adjustments decreasing federal AGI (line 8, Nebraska Schedule I, Form 1040XN). . . . . . . . . . . . . . . . . . . . . .1314 Nebraska Taxable Income (line 11 plus line 12 minus line 13). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1415 Nebraska income tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1516 Nebraska other tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1617 Total Nebraska tax before Nebraska personal exemption credit (line 15 plus line 16). . . . . . . . . . . . . . . . . . . .17Complete Page 2.revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-57298-773-2019
FORM 1040XN2019Page 2Computation of Tax(Attach documentation for any change in credits to lines 20 through 34 – see instructions)Correct Amount18 Nebraska personal exemption credit for residents only ( 137 times the number on line 4) . . . . . . . . . . .19 Credit for tax paid to another state from line 6, Nebraska Schedule II, Form 1040XN (attach NebraskaSchedule II and a copy of the other state’s dated return). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Credit for the elderly or the disabled (Claim only credit for the elderly or disabled, other federal credits arenot allowed.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Community Development Assistance Act (CDAA) credit . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Form 3800N nonrefundable credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Nebraska child/dependent care nonrefundable credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Credit for financial institution tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Employer’s credit for expenses incurred for TANF (ADC) recipients (see instructions) . . . . . . . . . . . . .26 School Readiness Tax Credit for providers (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . .27 Total nonrefundable credits (total of lines 18 through 26) . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Nebraska tax after nonrefundable credits (line 17 minus line 27 - see instructions) If less than zero, enter -0-.29 Total Nebraska income tax withheld (2019 Forms W-2, K-1N, W-2G, 1099-R, 1099-MISC, or others – see instr.)30 2019 estimated income tax payments (including any 2018 amount carried over) . . . . . . . . . . . . . . . .31 Form 3800N refundable credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 Nebraska child/dependent care refundable credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 Beginning Farmer credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Nebraska earned income credit (EIC). Number of qualifying children 97Federal credit 98x .10 (10%). Enter the result on line 34. Partial-year residents shouldcomplete lines 12 and 13, Schedule III (new SSN holders see instructions) . . . . . . . . . . . . . . . . . . .35 Angel Investment Tax Credit (see Form 1040N instructions) . . . . . . . . . . . . . . . . . . . . . . . . . .36 Credit for qualified Volunteer Emergency Responders . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 School Readiness Tax Credit for qualified staff members . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Amount paid with original return, plus additional tax payments made after it was filed . . . . . . . . . . . . .39 Total payments (add lines 29 through 38) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 Overpayment allowed on original return, plus additional overpayments of tax allowed after it was filed . . . .41 Actual tax paid, line 39 minus line 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 Penalty for underpayment of estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Total tax and penalty for underpayment of estimated tax (total of lines 28 and 42) . . . . . . . . . . . . .44 Use tax reported on line 41 of Form 1040N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Total Amount Due. If line 43 is greater than line 41 minus line 44, subtract the result of line 41minus line 44 from line 43. Otherwise, skip to line 49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 Penalty (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 Total Balance Due (total of lines 45 through 47). Pay in full with this return.Check this box if your payment is being made electronically . . . . . . . . . . . . . . . . . . . . . .49 Refund to be received (If line 43 is less than line 41 minus line 44, subtract line 43 from the result of line 41minus line 44.) Allow three months for your refund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243444546474849Explanation of Changes (Reference change and line number. If necessary attach additional sheets for explanation):50a Routing Number50b Type of Account(Enter 9 digits. First two digits must be 01 through 12, or 21 through 32.Use an actual check or savings account number, not a deposit slip.)50c Account Number50d Check this box if this refund will go to a bank account outside the United States.signherepaidpreparer’suse onlyCheckingSavings(Can be up to 17 characters. Omit hyphens,spaces, and special symbols. Enter from leftto right.)Under penalties of perjury, I declare that, as taxpayer or preparer, I have examined this return and to the best of my knowledge and belief, it is correct and complete.Your SignatureDateEmail Address()Spouse’s Signature (if filing jointly, both must sign)Daytime PhonePreparer’s SignatureDatePreparer’s PTINEmail Address( )Print Firm’s Name (or yours if self-employed), Address and Zip CodeEINMail this return and payment to: Nebraska Department of Revenue, PO Box 98911, Lincoln, NE 68509-8911.Daytime Phone
FORM 1040XNSchedulesI, II, and IIINEBRASKA SCHEDULE I — Nebraska Adjustments to IncomeNEBRASKA SCHEDULE II — Credit for Tax Paid to Another StateNEBRASKA SCHEDULE III — Computation of Nebraska TaxName on Form 1040XN2019Social Security NumberNebraska Schedule I — Nebraska Adjustments to Incomefor Nebraska Residents, Partial-Year Residents, and NonresidentsPART A — Adjustments Increasing Federal Adjusted Gross Income (AGI)1 Total adjustments increasing federal AGI (include interest from non-Nebraska state and local obligations).Enter here and on line 12, Form 1040XN. See instructions, then list items being changed.Correct Amount1PART B — Adjustments Decreasing Federal AGI2 State income tax refund deduction.23 Interest or dividend income from U.S. obligations.34 Benefits paid by the Railroad Retirement Board (RRB) included in federal AGI.45 Special capital gains/extraordinary dividends deduction (see instructions).56 Nebraska College Savings Program. 67 Other adjustments decreasing federal AGI (see instructions). List adjustments being changed andattach documentation78 Total adjustments decreasing federal AGI (add lines 2 through 7). Enter here and on line 13, Form 1040XN.8Nebraska Schedule II — Credit for Tax Paid to Another State for Full-Year Residents Only If line 2 or 3 is amended, a copy of the return filed with another state must be attached.Correct Amount1 Total Nebraska tax (line 17, Form 1040XN).2 AGI derived from another state (Do not enter the amount of taxable income from the other state. Use theConversion Chart on DOR’s website.).3 Ratio (Calculate to six decimal places, and round to five)Line 2 From Form 1040XN, Line 5 Line 12 – Line 13 4 Calculated Tax Credit. Line 1 multiplied by line 3 ratio .5 Tax due and paid to another state (Do not enter the amount of income tax withheld for the other state. Use theConversion Chart on DOR’s website.).6 Allowable tax credit (line 1, 4, or 5, whichever is least). Enter amount here and on line 19, Form 1040XN.1234.56Nebraska Schedule III — Computation of Nebraska Tax Nonresidents and partial-year residents complete lines 1 through 13 below.Correct Amount1 Income derived from Nebraska sources.12 Adjustments as applied to Nebraska income. Refer to Form 1040N instructions and list the items beingchanged . 23 Nebraska AGI (line 1 minus line 2) .34 Ratio – Nebraska’s share of the total income (Calculate to six decimal places, and round to five)Line 3 From Form 1040XN, Line 5 Line 12 - Line 13 45 Nebraska Taxable Income (from line 14, Form 1040XN).56 Nebraska total income tax (see instructions) , minus credits: . Enter difference here.67 Enter Nebraska personal exemption credit (if any).78 Tax after personal exemption credit (line 6 minus line 7) If less than zero, enter -0-.89 Nebraska share of line 8 (multiply line 8 by line 4 ratio). Enter here and on line 15, Form 1040XN.910 Nebraska other tax (see instructions). 1011 Nebraska share of line 10. Subtract any unused personal exemption credit from line 7.Multiply the result by the line 4 ratio. Enter here and on line 16, Form 1040XN. 1112 Earned income credit (partial-year residents only). Number of qualifying childrenFederal earned income creditx .10 (10%). 1213 Partial-year residents, multiply line 12 by line 4 ratio. Enter here and on line 34, Form 1040XN. 13.
Amended Nebraska Individual Income Tax Returnfor Tax Year 2019This Form 1040XN can only be used when amending tax year 2019.Do not use Form 1040XN to change the amount of use tax reported (see instructions for line 44 below).When to FileForm 1040XN is filed when:u The 2019 federal income tax return, or another state’s 2019 income tax return, is amended orcorrected; oru The information on the 2019 Nebraska income tax return that was previously filed is not correct.Form 1040XN may only be filed after an original Nebraska income tax return has been filed usingForm 1040N.An amended Nebraska income tax return must be filed within 60 days after the filing of an amendedfederal income tax return. However, if the amended federal income tax return requests a credit orrefund, the amended Nebraska income tax return must be filed within 60 days after receipt of proofof federal acceptance of the credit or refund.An amended Nebraska income tax return reporting a change or correction to another state’s incometax return must also be filed within 60 days after the amended income tax return is filed with the otherstate, or the correction becomes final.To establish timeliness of the refund claim, attach dated copies of:u The federal claim for refund;u The IRS audit determination; oru The amended federal or state income tax return.Filing 1040XN to Claim a Credit or Refund. Unless otherwise provided by statute:u When claiming a credit or refund due to overpayment, Form 1040XN must be filed –P Within three years of the due date, the actual date of filing under an approved extension,or the date the original income tax return was filed; orP Within two years from the time the tax was paid;whichever is later.u When claiming a credit or refund of a refundable credit, Form 1040XN must be filed within threeyears of the due date, or the actual date of filing under an approved extension of the income taxreturn (whichever is later) for the year in which the refundable credit was allowable.u Form 1040XN must be filed to claim a refund resulting from a federal or state change within twoyears and 60 days following the final determination of the change (but not more than 10 yearsfrom the due date of the original income tax return in the case of a change made by another state).u If you file an amended federal income tax return which will result in a credit or refund, do notsubmit the Nebraska amended income tax return until you can attach proof of federal acceptance.A hearing may be requested when filing for a refund on Form 1040XN by writing the request in theExplanation of Changes section of the form or by attaching a request for hearing to the Form 1040XN.Protective Claim. When an amended federal income tax return has been filed as a protective claim,an amended Nebraska income tax return filed as a protective claim is not necessary and should notbe filed. The payment of a refund by the IRS on a protective claim is a federal change that must bereported within 60 days of the refund.1
Nebraska Net Operating Loss (NOL). When carrying back a Nebraska net operating loss, you mustattach a copy of the completed Nebraska Net Operating Loss Worksheet, Form NOL, and a copy ofeither Federal Form 1045 or 1040X and all supporting schedules. The Nebraska Net Operating LossWorksheet, Form NOL, must be completed for the loss year and retained in your records until theloss is used. When the loss is used, you must attach a Form NOL for each previously established lossyear being used. Any federal NOL deduction is entered on line 1 of Schedule I, Form 1040XN, andthe amount of the Nebraska NOL deduction is entered on line 7 of Schedule I.Amending an E-filed Return. E-filed income tax returns are amended by filing a paper Form 1040XN.Amounts and other information needed for completing the amended income tax return should beavailable on saved or printed copies of the original Form 1040N return. If help is needed in completingthe amended income tax return, contact Taxpayer Assistance (see contact information).Taxpayer Assistance. Nebraska Department of Revenue (DOR) taxpayer assistance offices arelocated in Lincoln and Omaha. The Omaha office is open from 7
The information on the 2019 Nebraska income tax return that was previously filed is not correct. Form 1040XN may only be filed after an original Nebraska income tax return has been filed using Form 1040N. An amended Nebraska income tax return must be filed within 60 days after the filing of an amended federal income tax return.
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