Application for Tentative Refund                                                                  OMB No. 1545-0098
Form 1045                                                                   ▶ For individuals, estates, or trusts.  
                                                                   ▶
Department of the Treasury                                          Mail in separate envelope. (Don’t attach to tax return.) 
Internal Revenue Service                                ▶ Go to www.irs.gov/Form1045 for instructions and the latest information.                                       2021
                           Name(s) shown on return                                                                                              Social security or employer identification number

                           Number, street, and apt. or suite no. If a P.O. box, see instructions.                                               Spouse’s social security number (SSN)

                           City, town or post office, state, and ZIP code. If a foreign address, also complete spaces below (see instructions). Daytime phone number
             Type or print
                           Foreign country name                              Foreign province/county                                            Foreign postal code

1                          This application is     a  Net operating loss (NOL) (Sch. A, line 24)  b  Unused general business credit                      c  Net section 1256 contracts loss
                           filed to carry back:       $                                              $                                                      $ 
2 a                        For the calendar year 2021, or other tax year                                                                        b  Date tax return was filed
                           beginning                                    , 2021, and ending                  , 20

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

4                          If 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, entera  SSN ▶                                                     and   bYear(s) ▶

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

7                          Have you filed a petition in Tax Court for the year(s) to which the carryback is to be applied?  .                             .    . . .        Yes       No

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 a net section 1256 contracts loss, did this cause the release of foreign tax 
                           credits or 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:  If1a                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                         Excess  advance  premium  tax  credit 
                           repayment (see instructions) .    .     .    .

18                         Alternative minimum tax  .      . .     .    .

19                         Add lines 16 through 18      .  . .     .    .
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.                                                     Cat. No. 10670A            Form 1045 (2021)

Form 1045 (2021)                                                                                                                                                Page 2 

     Computation of Decrease in Tax                                   preceding        preceding                           preceding
     (continued)
                                                   tax year ended ▶                    tax year ended ▶          tax year ended ▶
                                                   Before                       After  Before           After       Before          After 
                                                   carryback                 carryback carryback      carryback    carryback        carryback

20   General business credit (see instructions) 

21   Net premium tax credit (see instructions)  

22   Other credits. Identify  .     .       . . . .

23   Total credits. Add lines 20 through 22 

24   Subtract line 23 from line 19  .         . . .

25   Self-employment tax (see instructions)

26   Additional Medicare Tax (see instructions)  
27   Net  Investment  Income  Tax  (see 
     instructions)  .        .  . . .       . . . .
28   Health  care:  individual  responsibility 
     (see instructions)  .        . .       . . . .

29   Other taxes  .          .  . . .       . . . .

30   Total tax. Add lines 24 through 29 .         .
31   Enter the amount from the “After carryback” 
     column on line 30 for each year .        . . .

32   Decrease in tax. Line 30 minus line 31

33   Overpayment of tax due to a claim of right adjustment under section 1341(b)(1) (attach computation)            .      . .
                  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.
                  ▲
Sign               Your signature                                                                                          Date
Here  
Keep a copy of 
this application  ▲
for your records.  Spouse’s signature. If Form 1045 is filed jointly, both must sign.                                      Date

                 Print/Type preparer’s name        Preparer’s signature                Date                                PTIN
                                                                                                        Check           if 
                                                                                                        self-employed
Paid 
Preparer 
Use Only         Firm’s name ▶                                                                          Firm’s EIN ▶

                 Firm’s address ▶                                                                       Phone no.
                                                                                                                               Form 1045 (2021)

Form 1045 (2021)                                                                                                 Page 3 
Schedule A—NOL (see instructions)

1  For individuals, subtract your standard deduction or itemized deductions from your adjusted gross 
   income and enter it here. For estates and trusts, enter taxable income increased by the total of the 
   charitable deduction, income distribution deduction, and exemption amount (see instructions)   . .    1 
2  Nonbusiness  capital  losses  before  limitation.  Enter  as  a  positive  number 
   (see instructions)  .   . . . . . . .    .   .      . .   .   . . . . .       .     2 
3  Nonbusiness capital gains (without regard to any section 1202 exclusion)            3 
4  If line 2 is more than line 3, enter the difference. Otherwise, enter -0-  .  .     4 
5  If line 3 is more than line 2, enter the difference. 
   Otherwise, enter -0-   .  . . . . . .    .   .          5 
6  Nonbusiness deductions (see instructions)  . .      . .   .   . . . . .       .     6 
7  Nonbusiness income other than capital gains (see 
   instructions)  .    . . . . . . . . .    .   .          7 
8  Add lines 5 and 7   .   . . . . . . .    .   .      . .   .   . . . . .       .     8 
9  If line 6 is more than line 8, enter the difference. Otherwise, enter -0-   . .   . .  . . . . . .    9 
10 If line 8 is more than line 6, enter the difference. 
   Otherwise, enter -0-. But don’t enter more than 
   line 5        . . . . . . . . . . . .    .   .        10 
11 Business capital losses before limitation. Enter as a positive number  .      .     11 
12 Business  capital  gains  (without  regard  to  any 
   section 1202 exclusion)  .  . . . . .    .   .        12 
13 Add lines 10 and 12  .    . . . . . .    .   .      . .   .   . . . . .       .     13 
14 Subtract line 13 from line 11. If zero or less, enter -0-   . . . . . .       .     14 
15 Add lines 4 and 14  .   . . . . . . .    .   .      . .   .   . . . . .       .     15 
16 Enter the loss, if any, from line 16 of your 2021 Schedule D (Form 1040). 
   (For estates and trusts, enter the loss, if any, from line 19, column (3), of
   Schedule D (Form 1041).) Enter as a positive number. If you don’t have a 
   loss on that line (and don’t have a section 1202 exclusion), skip lines 16 
   through 21 and enter on line 22 the amount from line 15  .      . . . .       .     16 
17 Section 1202 exclusion. Enter as a positive number (see instructions)  .      .   . .  . . . . . .    17 
18 Subtract line 17 from line 16. If zero or less, enter -0-  .  . . . . .       .     18 
19 Enter the loss, if any, from line 21 of your 2021 Schedule D (Form 1040). 
   (For estates and trusts, enter the loss, if any, from line 20 of Schedule D 
   (Form 1041).) Enter as a positive number .   .      . .   .   . . . . .       .     19 
20 If line 18 is more than line 19, enter the difference. Otherwise, enter -0-  .      20 
21 If line 19 is more than line 18, enter the difference. Otherwise, enter -0-  .    . .  . . . . . .    21 
22 Subtract line 20 from line 15. If zero or less, enter -0-  .  . . . . .       .   . .  . . . . . .    22 
23 NOL deduction for losses from other years. Enter as a positive number         .   . .  . . . . . .    23
24 NOL. Combine lines 1, 9, 17, and 21 through 23. If the result is less than zero, enter it here and on 
   page 1, line 1a. If the result is zero or more, you don’t have an NOL .       .   . .  . . . . . .    24
                                                                                                            Form 1045 (2021)

Form 1045 (2021)                                                                                  Page 4 
Schedule B—NOL Carryover (see instructions)

Complete one column before going to               preceding      preceding        preceding
the next column. Start with the earliest  
carryback year.                                   ▶              tax year ended ▶ tax year ended ▶
                                                  tax year ended 
1   NOL  deduction.  Enter as  a  positive 
    number       .  . . .    . .  . .     . .
2   Taxable  income  before  2021  NOL 
    carryback (see instructions). For estates 
    and trusts, increase this amount by the 
    sum  of  the  charitable  deduction  and 
    income  distribution  deduction  (see 
    instructions) .   . .    . .  . .     . .
3   Net  capital  loss  deduction  (see 
    instructions)  .  . .    . .  . .     . .
4   Section  1202  exclusion.  Enter  as  a 
    positive number (see instructions)  .   .
5   Domestic        production      activities 
    deduction (see instructions)  . .     . .
6   Adjustment  to  adjusted  gross  income  
    (see instructions)  .    . .  . .     . .
7   Adjustment  to  itemized  deductions 
    (see instructions)  .    . .  . .     . .
8   For  individuals,  enter  deduction  for 
    exemptions.  For  estates  and  trusts, 
    enter exemption amount  .     . .     . .
9   Modified  taxable  income.  Combine 
    lines 2 through 8. If zero or less, enter 
    -0- (see instructions)  .  .  . .     . .
10  NOL carryover (see instructions)  .     .
    Adjustment  to  Itemized  Deductions 
    (Individuals  Only) Complete  lines  11 
    through 38 for the carryback year(s) for 
    which you itemized deductions         only if 
    line 3, 4, or 5 above is more than zero.
11  Adjusted  gross  income  before  2021 
    NOL carryback  .    .    . .  . .     . .
12  Add lines 3 through 6 above     .     . .
 13 Modified  adjusted  gross  income.  Add  
    lines 11 and 12  .  .    . .  . .     . .
14  Medical  expenses  from  Sch.  A  (Form 
    1040), line 4, or as previously adjusted
15  Medical  expenses  from  Sch.  A  (Form 
    1040), line 1, or as previously adjusted
16  Multiply  line  13  by  percentage  from 
    Sch. A (Form 1040), line 3    . .     . .
 17 Subtract line 16 from line 15. If zero or 
    less, enter -0-  .  .    . .  . .     . .
18  Subtract line 17 from line 14 . .     . .
19  Mortgage  insurance  premiums  from 
    Sch. A (Form 1040), line 8d (line 13 for 
    years  before  2018),  or  as  previously 
    adjusted  .     . . .    . .  . .     . .
20  Refigured       mortgage      insurance 
    premiums (see instructions)  .  .     . .
21  Subtract line 20 from line 19   .     . .
                                                                                  Form 1045 (2021)

Form 1045 (2021)                                                                                   Page 5 
Schedule B—NOL Carryover (continued)

Complete one column before going to                preceding      preceding        preceding
the next column. Start with the earliest  
carryback year.                                    ▶              tax year ended ▶ tax year ended ▶
                                                   tax year ended 
22  Modified  adjusted  gross  income  from 
    line 13 on page 4 of the form  .      . .
23  Enter  as  a  positive  number  any  NOL  
    carryback from a year before 2021 that 
    was deducted to figure line 11 on page 
    4 of the form .  . . .     . . .      . .
24  Add lines 22 and 23  .     . . .      . .
25  Charitable  contributions  from  Sch.  A 
    (Form  1040),  line  14  (line  19  for  years 
    before 2018), or Sch. A (Form 1040-NR), 
    line 5, or as previously adjusted .   . .  
26  Refigured charitable contributions (see 
    instructions)  . . . .     . . .      . .
27  Subtract line 26 from line 25  .      . .
28  Casualty  and  theft  losses  from  Form 
    4684, line 18 .  . . .     . . .      . .
29  Casualty  and  theft  losses  from  Form 
    4684, line 16 .  . . .     . . .      . .
30  Multiply line 22 by 10% (0.10)  .     . .
 31 Subtract line 30 from line 29. If zero or 
    less, enter -0-  . . .     . . .      . .
32  Subtract line 31 from line 28  .      . .
33  Miscellaneous  itemized  deductions 
    (for  years  before  2018)  from  Sch.  A 
    (Form  1040),  line  27,  or  Sch.  A  (Form 
    1040NR),  line  13,  or  as  previously 
    adjusted  .  .   . . .     . . .      . .
34  Miscellaneous  itemized  deductions 
    (for  years  before  2018)  from  Sch.  A 
    (Form  1040),  line  24,  or  Sch.  A  (Form 
    1040NR),  line  10,  or  as  previously 
    adjusted  .  .   . . .     . . .      . .
35  Multiply line 22 by 2% (0.02)  .      . .
 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  in  the 
    instructions.  Otherwise,  combine  lines  
    18, 21, 27, 32, and 37; enter the result 
    here and on line 7 (page 4)  . .      . .
                                                                                   Form 1045 (2021)