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Sample Form 4549-A - Income Tax Examination ChangesThe sample form is an example of Form 4549-A, which is the basic report form prepared by examiners for unagreed and excepted agreed individual and corporate income tax cases. The sample form is an example of a completed form reflecting the taxpayer name and TIN, tax period, no adjustments, the figures for AGI per return and as corrected display the same number, the figures for Taxable Income per return and as corrected display the same number. Line 10 (b) Plus Other Taxes displays a number of $17,388, representing the personal holding company tax. This same number is also shown on Line 14 as the Deficiency and on Line 16 as the Balance Due. Additionally there is a comment in the Other Information: See attachment for notices and other information.