1045 Form – Fill Out and Use This PDF

1

This application is filed

a Net operating loss (NOL) (Sch. A, line 25, page 2)

b Unused general business credit

c Net section 1256 contracts loss

to carry back:

8, 2012

AugustIf

$

$

$

2a

For the calendar year 2012, or other tax year

b Date tax return was filed

beginning

, 2012, and ending

, 20

3

If this application is for an unused credit created by another carryback, enter year of first carryback ▶

4

you filed a joint return (or separate return) for some, but not all, of the tax years involved in figuring the carryback, list the

years and specify whether joint (J) or separate (S) return for each ▶

5

If SSN for carryback year is different from above, enter a SSN ▶

and b Year(s) ▶

6

If you changed your accounting period, give date permission to change was granted ▶

creditsDOor

NOT FILE

No

7

Have you filed a petition in Tax Court for the year(s) to which the carryback is to be applied? . .

. . .

Yes

8

Is any part of the decrease in tax due to a loss or credit resulting from a reportable transaction required to be

disclosed on Form 8886, Reportable Transaction Disclosure Statement?

. . . . . . . . .

. . .

Yes

No

9

If you are carrying back an NOL or net section 1256 contracts loss, did this cause the release of foreign tax

the release of other credits due to the release of the foreign tax credit (see instructions)? . . .

Yes

No

Computation of Decrease in Tax

preceding

preceding

preceding

(see instructions)

tax year ended ▶

tax year ended ▶

tax year ended ▶

Note: If 1a and 1c are blank, skip lines 10 through 15.

Before

After

Before

After

Before

After

carryback

carryback

carryback

carryback

carryback

carryback

10

NOL deduction after carryback (see instructions)

11

Adjusted gross income

12

Deductions (see instructions) . . .

13

Subtract line 12 from line 11 . . .

14

Exemptions (see instructions) . . .

15

Taxable income. Line 13 minus line 14

16

Income tax. See instructions and

attach an explanation

17

Alternative minimum tax

18

Add lines 16 and 17

19

General business credit (see instructions)

20

Other credits. Identify

21

Total credits. Add lines 19 and 20 . .

22

Subtract line 21 from line 18 . . .

23

Self-employment tax

24

Other taxes

25

Total tax. Add lines 22 through 24 . .

26

Enter the amount from the “After

carryback” column on line 25 for each year

27

Decrease in tax. Line 25 minus line 26

28

Overpayment of tax due to a claim of right adjustment under section 1341(b)(1) (attach computation) . . .

Sign

Under penalties of perjury, I declare that I have examined this application and accompanying schedules and statements, and to the best of my knowledge

and belief, they are true, correct, and complete.

Here

▲

Your signature

Date

Keep a copy of

▲

Spouse’s signature. If Form 1045 is filed jointly, both must sign.

Date

this application

for your records.

Paid

Print/Type preparer’s name

Preparer’s signature

Date

Check

if

PTIN

self-employed

Preparer

Firm’s name ▶

Firm's EIN ▶

Use Only

Firm’s address ▶

Phone no.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.

Cat. No. 10670A

Form 1045 (2012)

Form 1045 (2012)

Page 3

Schedule B—NOL Carryover (see instructions)

Complete one column before going to the

next column. Start with the earliest

preceding

preceding

preceding

carryback year.

tax year ended ▶

tax year ended ▶

tax year ended ▶

August 8, 2012

instructions)

4

Section 1202 exclusion. Enter as a

positive number

5

Domestic

production

activities

deduction

previously adjusted)

20

Refigured

mortgage

insurance

premiums (see instructions) . . . .

21

Subtract line 20 from line 19 . . .

Form 1045 (2012)

Page 4

Schedule B—NOL Carryover (Continued)

Complete one column before going to the

next column. Start with the earliest

preceding

preceding

preceding

carryback year.

tax year ended ▶

tax year ended ▶

tax year ended ▶

22

Modified adjusted gross income from

line 13 on page 3 of the form . . .

23

Enter as a positive number any NOL

AS

OF

carryback from a year before 2012 that

was deducted to figure line 11 on page

24

3 of the form

Add lines 22 and 23

DRAFT

25

Charitable contributions from Sch. A

(Form 1040), line 19 (line 18 for 2002

through 2006), or Sch. A (Form 1040NR),

line 7 (or as previously adjusted) . . .

26

Refigured charitable contributions (see

8,

20

12

instructions)

August

27

Subtract line 26 from line 25 . . .

28

Casualty and theft losses from Form

4684, line 18 (line 23 for 2008; line 21

for 2009; line 20 for 2005, 2006, and

2010)

29

Casualty and theft losses from Form

T

FILE

4684, line 16 (line 21 for 2009; line 18

for 2005,DO2006, and 2009; line 17NOfor

2010)

30

Multiply line 22 by 10% (.10) . . .

31

Subtract line 30 from line 29. If zero or

less, enter -0-

32

Subtract line 31 from line 28 . . .

33

Miscellaneous itemized deductions

from

Sch. A (Form 1040), line 27 (line 26 for

2002 through 2006), or Sch. A (Form

1040NR), line 15 (or as previously adjusted)

34

Miscellaneous itemized deductions

from

Sch. A (Form 1040), line 24 (line 23 for

2002 through 2006), or Sch. A (Form

1040NR), line 12 (or as previously adjusted)

35

Multiply line 22 by 2% (.02) . . . .

36

Subtract line 35 from line 34. If zero or

less, enter -0-

37

Subtract line 36 from line 33 . . .

38

Complete the worksheet in the

instructions if line 22 is more than the

applicable amount shown below (more

than one-half that amount if married

filing separately for that year).

• $137,300 for 2002.

• $139,500 for 2003.

• $142,700 for 2004.

• $145,950 for 2005.

• $150,500 for 2006.

• $156,400 for 2007.

• $159,950 for 2008.

• $166,800 for 2009.

Otherwise, combine lines 18, 21, 27,

32, and 37; enter the result here and

on line 7 (page 3)