ARIZONA FORM |
Resident Personal Income Tax Return |
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FOR |
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140 |
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CALENDAR YEAR |
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OR FISCAL YEAR BEGINNING |
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M |
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D |
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D |
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Y |
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Y |
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Y |
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AND ENDING |
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D |
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Y |
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Y |
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Y |
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66 |
2012 |
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82F |
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Check box 82F if filing under extension |
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Your First Name and Middle Initial |
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Last Name |
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Enter |
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Your Social Security No. |
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1 |
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Spouse’s First Name and Middle Initial (if box 4 or 6 checked) |
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Last Name |
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your |
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Spouse’s Social Security No. |
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SSN(s) |
. |
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1 |
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Current Home Address - number and street, rural route |
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Apt. No. Daytime Phone (with area code) |
Home Phone (with area code) |
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2 |
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94 |
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City, Town or Post Office |
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State Zip Code |
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3 |
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corner.leftupper |
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STATUSFILING |
4 |
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Married filing joint return |
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REVENUE USE ONLY. DO NOT MARK IN THIS AREA. |
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5 |
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Head of household |
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NAME OF QUALIFYING CHILD OR DEPENDENT |
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6 |
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Married filing separate return. Enter spouse’s name and Social Security No. above. |
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7 |
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Single |
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staple2;pageto |
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EXEMPTIONS |
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Enter the number claimed. Do not put a check mark. |
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8 |
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Age 65 or over (you and/or spouse) |
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88 |
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9 |
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Blind (you and/or spouse) |
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10 |
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Dependents. From page 2, line A2 – do not include self or spouse. |
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11 |
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Qualifying parents and grandparents. From page 2, line A5. |
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81 |
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80 |
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140 |
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12 |
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Federal adjusted gross income (from your federal return) |
..................................................................................................... |
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12 |
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00 |
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13 |
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Additions to income (from page 2, line B12) |
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13 |
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00 |
Form |
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14 |
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Subtractions from income (from page 2, line C17 or line C30) |
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14 |
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00 |
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after |
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15 |
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Arizona adjusted gross income. Add lines 12 and 13 then subtract line 14 |
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15 |
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00 |
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documents |
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16 |
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Deductions: Check box and enter amount. See instructions, pages 14 and 15... |
16I ITEMIZED 16S |
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STANDARD |
16 |
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00 |
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19 |
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......................................................Compute the tax using amount on line 18 and Tax Table X, Y or Optional Tax Tables |
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19 |
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00 |
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17 |
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Personal exemptions. See page 15 of the instructions |
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17 |
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00 |
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18 |
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Arizona taxable income: Subtract lines 16 and 17 from line 15. If less than zero, enter zero |
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18 |
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00 |
other |
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20 |
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Tax from recapture of credits from Arizona Form 301, Part II, line 35 |
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20 |
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00 |
or |
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21 |
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Subtotal of tax: Add lines 19 and 20 |
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21 |
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00 |
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22 |
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Family income tax credit (from worksheet on page 16 of instructions) |
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22 |
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00 |
schedules |
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23 |
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Credits from Arizona Form 301, Part II, line 68, or Forms 310, 321, 322, and 323 if Form 301 is not required |
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23 |
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00 |
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24 |
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Credit type: Enter form number of each credit claimed |
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24 |
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3 |
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3 |
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3 |
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3 |
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.............. |
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25 |
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25 |
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00 |
AZ |
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Clean Elections Fund Tax Credit for donations made prior to August 2, 2012 (from worksheet on page 18 of the instructions) |
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26 |
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Balance of tax: Subtract lines 22, 23 and 25 from line 21. |
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26 |
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00 |
and |
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If the sum of lines 22, 23 and 25 is more than line 21, enter zero |
........... |
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27 |
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Arizona income tax withheld during 2012 |
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27 |
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00 |
federal |
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28 |
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Arizona estimated tax payments for 2012 |
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28 |
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00 |
required |
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29 |
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2012 Arizona extension payment (Form 204) |
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29 |
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00 |
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30 |
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Increased Excise Tax Credit (from Form 140PTC or worksheet on page 19 of the instructions) |
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30 |
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00 |
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31 |
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Property Tax Credit from Form 140PTC |
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31 |
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00 |
any |
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32 |
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Other refundable credits: Check the box(es) and enter the amount |
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321 Form 308-I 322 |
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Form 342 |
32 |
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00 |
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33 |
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Total payments/refundable credits: Add lines 27 through 32 |
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33 |
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00 |
Place |
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34 |
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TAX DUE: If line 26 is larger than line 33, subtract line 33 from line 26 and enter amount of tax due. Skip lines 35, 36 and 37 |
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34 |
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00 |
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........... |
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35 |
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OVERPAYMENT: If line 33 is larger than line 26, subtract line 26 from line 33 and enter amount of overpayment |
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35 |
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00 |
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36 |
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Amount of line 35 to be applied to 2013 estimated tax |
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36 |
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00 |
TAPE. |
37 |
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Balance of overpayment: Subtract line 36 from line 35 |
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37 |
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00 |
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38 - 47 Voluntary Gifts to: |
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NO |
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Aid to Education |
38 |
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00 |
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Arizona Wildlife |
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39 |
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00 |
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Child Abuse Prevention |
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40 |
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00 |
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Domestic Violence Shelter |
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41 |
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00 |
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HERE. |
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I Didn’t Pay Enough Fund |
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42 |
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00 |
National Guard Relief Fund |
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43 |
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00 |
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Neighbors Helping Neighbors |
44 |
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00 |
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Special Olympics |
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45 |
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00 |
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PAYMENT |
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Veterans’ Donations Fund |
46 |
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00 |
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Political Gift |
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47 |
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00 |
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50 |
|
Check applicable boxes 501.... |
Annualized/Other |
502 |
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Farmer or Fisherman 503 |
Form 221 attached 504 |
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MSA Penalty |
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48 |
|
Voluntary Political Gift (check only one): |
481 |
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Americans Elect |
482 |
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Democratic |
483 |
Green |
484 |
Libertarian |
485 |
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Republican |
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49 |
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.................................................................................................Estimated payment penalty and MSA withdrawal penalty |
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49 |
00 |
STAPLE |
51 |
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Total of lines 38 through 47 and 49 |
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51 |
00 |
52 |
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REFUND: Subtract line 51 from line 37. |
If less than zero, enter amount owed on line 53 |
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52 |
00 |
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Direct Deposit of Refund: Check box 52A if your deposit will be ultimately placed in a foreign account; see instructions. |
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52A |
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ROUTING NUMBER |
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ACCOUNT NUMBER |
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C |
Checking or |
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98 |
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S |
Savings |
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53 |
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AMOUNT OWED: Add lines 34 and 51. |
Make check payable to Arizona Department of Revenue; include SSN on payment. |
53 |
00 |