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Form 1120X
(Rev. December 2004)
Amended U.S. Corporation
OMB No. 1545-0132
Please
Type Number, street, and room or suite no. (If a P.O. box, see instructions.)
or
Print City or town, state, and ZIP code Telephone number (optional)
( )
Enter name and address used on original return (If same as above, write “Same.”)
6 Tax deposited or paid with (or after) the filing of the original return 6
10 Tax due. Subtract line 9 from line 4, column (c). If paying by check, make it payable to the “United
States Treasury” 䊳 10
䊳
Date Preparer’s SSN or PTIN
Paid Preparer’s Check if
signature self-employed
Preparer’s
䊳
Firm’s name (or EIN
Use Only yours if self-employed),
Phone no. ( )
address, and ZIP code
For Privacy Act and Paperwork Reduction Act Notice, see page 4. Cat. No. 11530Z Form 1120X (Rev. 12-2004)
3
I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 1120X, PAGE 2 of 4
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE, WRITING, SUB. 20 INK: BLACK
FLAT SIZE: 432mm (17") x 279mm (11") FOLD TO: 216mm (8 1⁄2 ") x 279mm (11")
PERFORATE: (NONE)
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT