Sample Form 4549-A - Income Tax Examination Changes, Page 1The sample form is an example of Page 1 of Form 4549-A, which is the basic report form prepared by examiners for unagreed and excepted agreed individual and corporate income tax cases. Page 1 contains fields for the taxpayer name, TIN, proposed adjustments, and the resulting tax or overassessment. The sample form is an example of a completed form reflecting the taxpayer name, etc., but the details are not relevant to this exhibit.