AMENDED  INDIVIDUAL                                                 SF-1040X 
                                                                     TAX RETURN 
Enter calendar year of ending date of fiscal year of this return                                                    YEAR 
                                                                             MO / DAY / YEAR 
Part I                                 Identification and Information 
          First name, initial, spouse's name and initial                     Last name                              Social security number 
PLEASE 
          Present home address (number & street, including apartment)
TYPE OR                                                                              
                                                                                                                 Spouse's social security number
PRINT                                                                                                                                               
          City or Town                 State                                 Zip Code 

              IMPORTANT: Please answer all questions, fill in applicable items, and explain changes on pg. 2.                      
Enter name and address on original return. (if same as above write same) If changing from separate to joint return, enter names and 
addresses used on original returns. (Note you cannot change your filing status from joint to separate after the filing date)

          On original Return 
Residency     Resident                 Non-resident                                 Part-year resident from      to 
Status 
Claimed   On this Return 
              Resident                 Non-resident                                 Part-year resident from      to 
                                                                                              Exemptions: 
                                       Single Married filing  *Married filing
Filing                                                               jointly separately       On original Return    On This Return 
Status 
Claimed                                                                                       A  As originally   B  Net change          C  Correct 
          On original Return
          On this Return                                                                       Reported or       (increase or decrease  Amount
          *Give name & SSN of Spouse:                                                        _ as last adjusted  explain on pg. 2)
Part II    INCOME, ADDITIONS AND DEDUCTIONS 
1   TOTAL W-2 INCOME: (wages, salaries, tips, etc.) (Attach all W-2's) 
A. Residents: enter total W-2 Income.  B. Non-residents (See instructions)
2   ADDITIONS TO INCOME: All other income: (interest, dividends, business 
income, capital gains, rents, royalties, partnerships, estates, trusts, etc)
3   SUBTRACTIONS FROM INCOME (All allowed losses and adjustments) (See 
instructions)          (ATTACH ALL SCHEDULES AND EXPLANATIONS)
4   ADJUSTED INCOME (Add lines 1 and 2 less line 3)
5   EXEMPTIONS: Multiply the number of exemptions claimed by $750.00 
(for 1999 thru 2008 use $1500.00,and $600.00 for 1998 and prior years)
6   TAXABLE INCOME (line 4 less line 5)
7   TAX - Multiply amount on line 6 by one of the following 
A RESIDENT - 1% (.01) 
B NON-RESIDENT - 1/2% (.005) 
C PART-YEAR RESIDENT - 1% (.01) Tax on line 29 (SF-1040 Sch PY pg 1)
Part III   CREDIT AND PAYMENTS 
8   SPRINGFIELD tax withheld (Attach W-2 supplied by employer)

9   Estimate payments (including credit from overpayment)

10 Credits for income tax paid to another MI municipality or by a partnership

11 TOTAL PAYMENT AND CREDITS (Add lines 8, 9, and 10)

A  Amount paid with original return, plus additional tax paid after filing                                                             A

B  Total credits and payments. Add lines 11 and 12 of column C                                                                         B
Part IV    REFUND OR BALANCE DUE 
                                                                                                                                       C
C  Refund, if any shown on original return line 35 or 36 

D  Enter the difference between lines B and C (See instructions)                                                                       D

12 If line 7, column C, is greater than line D, enter BALANCE DUE                                                PAY IN FULL       12

13  If line 7, Column C, iiss lleessss tthhaann line D, enter REFUND to be received                                 REFUND         13

Part I    Exemptions                     Complete only if a change in exemptions 
                                                                  A  Number           B   Net Change C   Corrected number 
                                                                   originally 
                                                                   reported 
1 Exemptions - yourself and spouse 
2 Your dependent children who lived with you 
3 Other dependents 
4 Total exemptions (add lines 1 thru 3) 
5 Multiply the total number of exemptions claimed by 
  $750.00 (for 1999 thru 2008 use $1,500.00 and 
  $600.00 for 1998 and prior years) 
6 Enter first names of your dependent children who lived                                              Enter  
  with you, but were not claimed on original return:                                                 Number 
                                                                                                      Enter 
7  Other dependents not claimed on original return: 
                                                                                                     Number 
        Name                Relationship        Number of months   Did dependent have   Did you provide more that one- 
                                                lived in your home income of $750.00 or half of dependent's support?    
                                                                   more? 
                                                                          Yes      No           Yes         No
                                                                          Yes      No           Yes         No

Part II Explanation of changes to income, deductions, and credits 

        Enter the line reference from pg 1 for which you are reporting a change and  give the reason for each change. 
        Attach applicable schedules. 

                                        Instructions for filing the amended return 

Lines 1 thru 11 in column A should appear the same as they were last (as originally filed, as corrected by Springfield or as last 
amended). Column B should contain only the amount to be added or subtracted from that particular line. Column C should 
contain the correct amount. 

All amounts appearing in column B must be explained on pg 2, part II and must have all supporting documentation attached for 
verification, this includes but is not limited to the following: A copy of the Federal 1040X, IRS letter of adjustment, additional and 
or corrected schedules, forms, worksheets, etc. 

If you need assistance in preparing your Springfield return, you may come into our office or call 269-965-8324. Office hours are 
7:00 am to 6:00 pm, Monday thru Thursday. City Hall is closed on Fridays. 

Sign Here 
          Taxpayer's signature                  Date     Signature of preparer other than taxpayer   Date 

Sign Here 
          Spouse's signature                    Date     Address and phone number 

        Mail completed return to: City of Springfield, Income Tax Department, 601 Avenue A, Springfield, MI 49037-7774 
                                        (Make checks payable to: City of Springfield)