Arizona PDF Forms

Arizona PDF Forms

Homepage Fill Out Your Arizona 140Py Form
Table of Contents

The Arizona 140PY form is an essential document for individuals who have lived in the state for part of the tax year and are required to file a personal income tax return. Designed specifically for part-year residents, this form allows taxpayers to report their income earned while residing in Arizona, along with any applicable deductions and credits. The form requires basic personal information, including names, Social Security numbers, and residency status. Taxpayers must detail their federal adjusted gross income and calculate their Arizona taxable income by accounting for various additions and subtractions specific to state regulations. Additionally, the 140PY form includes sections for claiming exemptions, which can reduce taxable income, and for reporting any tax credits that may apply. Understanding the nuances of this form is crucial, as it not only determines tax liability but also ensures compliance with state tax laws. Filing accurately can lead to potential refunds or reduced tax due, making it a significant component of the annual tax process for part-year residents in Arizona.

Guide to Writing Arizona 140Py

Filling out the Arizona 140PY form can seem daunting, but breaking it down into manageable steps makes the process much easier. Once you have completed the form, you'll be ready to submit it to the Arizona Department of Revenue, either for a refund or to settle any tax dues. Here’s how to navigate the form step-by-step.

  1. Begin by checking the box for filing under extension if applicable.
  2. Enter your first name, middle initial, and last name.
  3. Provide your Social Security Number (SSN).
  4. If applicable, fill in your spouse’s first name, middle initial, last name, and SSN.
  5. Complete your current home address, including street number, apartment number (if any), city, state, and zip code.
  6. Enter your daytime phone number and home phone number.
  7. Select your filing status: married filing jointly, head of household, married filing separately, or single.
  8. Claim exemptions by entering the number of exemptions you are entitled to, including age, blindness, and dependents.
  9. Indicate your residency status by checking the appropriate box for part-year resident, either active military or other than active military.
  10. Report your federal adjusted gross income from your federal return on line 14.
  11. Enter your Arizona income on line 15, as calculated on page 2.
  12. Fill in any additions to income on line 16.
  13. Complete line 17 for any subtractions from income.
  14. Calculate your Arizona adjusted gross income by adding lines 15 and 16, then subtracting line 17.
  15. Choose between itemized or standard deductions on line 19 and enter the amount.
  16. Enter personal exemptions on line 20 as per instructions.
  17. Calculate your Arizona taxable income by subtracting lines 19 and 20 from line 18.
  18. Use the tax table to compute your tax on line 22.
  19. Add any recapture of credits from Arizona Form 301 on line 23.
  20. Calculate the subtotal of tax on line 24 by adding lines 22 and 23.
  21. Report any family income tax credit on line 25.
  22. Claim any additional credits on line 26.
  23. List any specific credit types claimed on line 27.
  24. Complete lines 28 through 39 for tax due, overpayment, and voluntary gifts.
  25. Sign and date the form, ensuring all information is accurate.
  26. Mail the completed form to the appropriate address based on whether you are sending a payment or expecting a refund.

Common Questions

What is the Arizona 140PY form?

The Arizona 140PY form is a personal income tax return specifically designed for part-year residents of Arizona. It allows individuals who lived in the state for only part of the tax year to report their income and calculate their tax liability accordingly. This form is essential for ensuring that taxpayers accurately reflect their residency status and income earned during their time in Arizona.

Who should file the Arizona 140PY form?

How do I determine my Arizona income for the 140PY form?

What exemptions can I claim on the Arizona 140PY form?

What should I do if I owe tax or am expecting a refund?

Dos and Don'ts

When filling out the Arizona 140PY form, it's essential to be thorough and accurate. Here are some important do's and don'ts to keep in mind:

  • Do double-check all personal information, including names and Social Security numbers, for accuracy.
  • Do ensure you have the correct residency dates clearly marked on the form.
  • Do follow the instructions carefully, especially regarding exemptions and deductions.
  • Do sign and date the form before submission to avoid delays.
  • Don't use tape or any other adhesive on the form; it can cause processing issues.
  • Don't leave any required fields blank; fill them out completely to prevent processing delays.
  • Don't forget to keep a copy of your completed form for your records.
  • Don't submit the form without checking for any errors or omissions.

Similar forms

The Arizona Form 140 is a personal income tax return for full-year residents. Like the 140Py, it is used to report income, claim deductions, and determine tax liability. The primary difference is that the 140 is for individuals who have lived in Arizona for the entire tax year, whereas the 140Py is specifically for part-year residents. Both forms require similar information, such as personal details, income sources, and exemptions, but the residency status section differs based on the duration of residency in Arizona.

The Arizona Form 140A is a simplified version of the 140 form, designed for taxpayers with a straightforward tax situation. Similar to the 140Py, it allows for the reporting of income and claiming of deductions. However, the 140A is limited to individuals who do not itemize deductions and have a lower income threshold. Both forms share common sections, such as personal information and tax calculation, but the 140A has fewer lines and requires less detailed reporting.

The Arizona Form 140NR is used by non-residents who earn income in Arizona. This form is similar to the 140Py in that both are designed for individuals who do not meet the full-year residency requirement. Both forms require taxpayers to report income earned within the state and allow for certain deductions. However, the 140NR focuses solely on income sourced from Arizona, while the 140Py encompasses income from both Arizona and other states during the part-year residency.

The Arizona Form 204 is an extension form that allows taxpayers to request additional time to file their tax returns. It is similar to the 140Py in that it requires personal information and tax year details. Both forms serve to inform the Arizona Department of Revenue about the taxpayer's status and intentions. However, the 204 does not calculate tax liability; it simply extends the deadline for filing the actual return.

The Arizona Form 301 is used for claiming various tax credits. It shares similarities with the 140Py in that both forms require taxpayers to provide information on income and tax liability. The 301 is specifically focused on credits that can reduce the overall tax owed, while the 140Py calculates the tax based on income and deductions. Taxpayers may use both forms together to ensure they maximize their tax benefits.

The Arizona Form 321 is a credit form for contributions to private school tuition organizations. This form is similar to the 140Py in that both require personal information and tax calculations. Taxpayers can use the 321 to claim a credit that directly reduces their tax liability, while the 140Py determines the overall tax owed based on income and deductions. Both forms are integral to the tax filing process in Arizona, particularly for those seeking to take advantage of available credits.

Key takeaways

When filling out and using the Arizona 140PY form, it is essential to keep several key points in mind to ensure accuracy and compliance. Here are four important takeaways:

  • Residency Status Matters: Clearly indicate your residency status. You must check the appropriate box for either "Part-Year Resident Other than Active Military" or "Part-Year Resident Active Military." This designation affects your tax obligations.
  • Accurate Income Reporting: Report your federal adjusted gross income accurately. This figure is crucial as it serves as the foundation for determining your Arizona taxable income. Ensure that you include all relevant income sources from your federal return.
  • Claiming Exemptions: Carefully calculate and enter the number of exemptions you are claiming. This includes exemptions for age, blindness, and dependents. Each exemption can significantly affect your taxable income, so accuracy is vital.
  • Filing Deadlines: Be aware of the filing deadlines. If you are filing under an extension, make sure to check the appropriate box. Timely submission can help you avoid penalties and interest on any tax due.

These takeaways will help you navigate the Arizona 140PY form more effectively. Always refer to the instructions provided with the form for specific guidance tailored to your situation.

Common mistakes

  1. Neglecting to read the instructions: Many people skip the instructions altogether. The guidelines provide essential information that can prevent errors.

  2. Incorrect residency dates: Failing to accurately enter the dates of Arizona residency can lead to complications. Ensure that the dates reflect your actual time living in Arizona.

  3. Missing Social Security Numbers: Omitting your Social Security Number or that of your spouse can delay processing. Always double-check that all required SSNs are included.

  4. Using check marks instead of numbers: Some individuals mistakenly mark checkboxes instead of entering the correct numerical values. This can result in misinterpretation of your claims.

  5. Errors in income calculations: Miscalculating your federal adjusted gross income can have significant repercussions. Take your time to ensure accuracy when transferring numbers from your federal return.

  6. Not claiming all eligible exemptions: Some filers overlook exemptions for age, blindness, or dependents. Review your situation carefully to maximize your potential deductions.

  7. Failing to sign and date the form: A common mistake is forgetting to sign and date the return. Without your signature, the form is considered incomplete.

  8. Incorrect mailing address: Sending your completed form to the wrong address can delay processing. Make sure to use the correct address based on whether you are sending a payment or expecting a refund.

  9. Not keeping a copy: Many people forget to keep a copy of their completed form. Retaining a copy is crucial for your records and can help if questions arise later.

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NO TAPE.

ARIZONA FORM

 

 

Part-Year Resident Personal Income Tax Return

 

 

 

 

FOR

 

 

 

140PY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CALENDAR YEAR

 

OR FISCAL YEAR BEGINNING

 

M

 

M

 

D

 

 

D

 

Y

 

Y

 

Y

 

Y

 

AND ENDING

 

M

 

M

 

D

 

D

 

Y

 

Y

 

Y

 

Y

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2012

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

82F

 

 

 

 

 

Check box 82F if filing under extension

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your First Name and Middle Initial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter

 

 

 

 

Your Social Security No.

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Spouse’s First Name and Middle Initial (if box 4 or 6 checked)

 

 

 

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spouse’s Social Security No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN(s)

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Home Address - number and street, rural route

 

 

 

Apt. No.

Daytime Phone (with area code)

 

 

 

Home Phone (with area code)

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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City, Town or Post Office

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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4

 

 

 

Married filing joint return

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

Head of household

NAME OF QUALIFYING CHILD OR DEPENDENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6

 

 

 

Married filing separate return. Enter spouse’s name and Social Security No. above.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

 

 

 

Single

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

page 2; staplecorner.uppertoleft

 

EXEMPTIONSSTATUSFILING

 

 

 

 

 

 

 

Enter the number claimed. Do not put a check mark.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

88

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8

 

 

 

 

Age 65 or over (you and/or spouse)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9

 

 

 

 

Blind (you and/or spouse)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10

 

 

 

 

Dependents. From page 2, line A2 – do not include self or spouse.

 

 

 

 

 

 

 

 

 

 

 

 

 

81

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

80

 

 

 

 

 

 

11

 

 

 

 

Qualifying parents and grandparents from page 2, line A5.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12-13 Residency Status (check one):

12

 

 

Part-Year Resident Other than Active Military

13

 

 

 

 

 

 

 

Part-Year Resident Active Military

 

 

140PY

 

 

 

 

 

 

 

 

 

 

 

 

 

14

 

Federal adjusted gross income (from your federal return)

...............................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

00

 

 

 

 

 

 

 

15

 

Arizona income (from page 2, line B19)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15

 

 

 

 

00

Form

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16

 

Additions to income (from page 2, line C24)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16

 

 

 

 

00

 

17

 

Subtractions from income (from page 2, line D36)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17

 

 

 

 

00

after

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18

 

Arizona adjusted gross income: Add lines 15 and 16 then subtract line 17

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18

 

 

 

 

00

documents

 

19

 

Deductions. Check box and enter amount. See instructions, page 16

19I

 

 

ITEMIZED 19S

 

 

 

STANDARD

 

19

 

 

 

 

00

 

20

 

Personal exemptions. See page 16 of the instructions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20

 

 

 

 

00

 

21

 

Arizona taxable income: Subtract lines 19 and 20 from line 18.

If less than zero, enter zero

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21

 

 

 

 

00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

00

other

 

22

 

Compute the tax using Tax Table X or Y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22

 

 

 

 

 

23

 

Tax from recapture of credits from Arizona Form 301, Part II, line 35

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23

 

 

 

 

00

or

 

24

 

Subtotal of tax: Add lines 22 and 23

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24

 

 

 

 

00

schedules

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25

 

Family income tax credit from worksheet on pages 17 and 18 of the instructions

.............................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25

 

 

 

 

00

 

26

 

Credits from Arizona Form 301, Part II, line 68, or Forms 310, 321, 322 and 323, if Form 301 is not required

 

 

 

 

 

 

 

 

 

 

26

 

 

 

 

00

 

27

 

Credit type: Enter form number of each credit claimed

 

 

 

 

 

 

 

 

 

 

 

 

27

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

..............

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AZ

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

28

 

Clean Elections Fund Tax Credit for donations made prior to August 2, 2012 (from worksheet on page 20 of the instructions)

 

28

 

 

 

 

00

and

 

 

 

 

 

 

 

 

29

 

Balance of tax: Subtract lines 25, 26 and 28 from line 24.

If the sum of lines 25, 26 and 28 is more than line 24, enter zero

 

 

 

 

 

 

 

 

 

 

29

 

 

 

 

00

federal

 

30

 

Arizona income tax withheld during 2012

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

30

 

 

 

 

00

 

31

 

Arizona estimated tax payments for 2012

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31

 

 

 

 

00

required

 

32

 

2012 Arizona extension payment (Form 204)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

32

 

 

 

 

00

 

33

 

Increased Excise Tax Credit: From worksheet on page 20 of the instructions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33

 

 

 

 

00

 

34

 

Other refundable credits: Check the box(es) and enter the amount

 

 

341

 

Form 308-I

342

 

 

 

Form 342

 

34

 

 

 

 

00

any

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35

 

Total payments/refundable credits: Add lines 30 through 34

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35

 

 

 

 

00

Place

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36

 

TAX DUE: If line 29 is larger than line 35, subtract line 35 from line 29, and enter amount of tax due. Skip lines 37, 38 and 39

 

 

 

 

 

 

 

 

 

 

36

 

 

 

 

00

 

37

 

OVERPAYMENT: If line 35 is larger than line 29, subtract line 29 from line 35, and enter amount of overpayment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37

 

 

 

 

00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

38

 

Amount of line 37 to be applied to 2013 estimated tax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

38

 

 

 

 

00

TAPE.

 

39

 

Balance of overpayment: Subtract line 38 from line 37

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

39

 

 

 

 

00

 

40 - 49 Voluntary Gifts to:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Aid to Education

 

 

 

 

 

 

40

 

 

 

 

 

 

 

 

 

 

 

 

 

00

Arizona Wildlife

 

 

 

 

 

 

 

 

 

 

 

 

 

 

41

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

00

 

 

 

 

 

 

 

NO

 

 

 

.................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Child Abuse Prevention

 

42

 

 

 

 

 

 

 

 

 

 

 

 

 

00

Domestic Violence Shelter

 

 

 

 

 

43

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

00

 

 

 

 

 

 

 

HERE.

 

 

 

I Didn’t Pay Enough Fund

 

44

 

 

 

 

 

 

 

 

 

 

 

 

 

00

National Guard Relief Fund

 

 

 

 

 

45

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

00

 

 

 

 

 

 

 

 

 

 

Neighbors Helping Neighbors

 

46

 

 

 

 

 

 

 

 

 

 

 

 

 

00

Special Olympics

 

 

 

 

 

 

 

 

 

 

 

47

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

00

 

 

 

 

 

 

 

 

 

 

 

Veterans’ Donations Fund

 

48

 

 

 

 

 

 

 

 

 

 

 

 

 

00

Political Gift

 

 

 

 

 

 

 

 

 

 

 

 

 

 

49

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

00

 

 

 

 

 

 

 

PAYMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

50

 

Voluntary Political Gift (check only one):

501 Americans Elect

502

 

 

 

Democratic 503

 

Green 504 Libertarian

505

 

 

 

Republican

 

 

 

 

 

51

 

Estimated payment penalty and MSA withdrawal penalty

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

51

 

 

 

00

 

52

 

....Check applicable boxes 521

Annualized/Other

522

 

 

 

Farmer or Fisherman 523

 

 

 

Form 221 attached 524

 

MSA Penalty

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STAPLE

 

53

 

Total of lines 40 through 49 and 51

....................................................................................................................................

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

53

 

 

 

00

 

54

 

REFUND: Subtract line 53 from line 39.

If less than zero, enter amount owed on line 55

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

54

 

 

 

00

 

 

 

 

Direct Deposit of Refund: Check box 54A if your deposit will be ultimately placed in a foreign account; see instructions

54A

 

 

 

 

 

 

 

 

 

 

 

 

 

ROUTING NUMBER

 

 

 

ACCOUNT NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

 

 

Checking or

 

 

 

 

 

 

 

 

 

 

 

 

98

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

Savings

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

55

 

AMOUNT OWED: Add lines 36 and 53.

 

Make check payable to Arizona Department of Revenue; include SSN on payment

55

 

 

 

00

ADOR 10149 (12)

Your Name (as shown on page 1)

Your Social Security No.

 

 

A1

List children and other dependents. Do not list yourself or spouse. If more space is needed,

 

 

 

 

 

 

 

 

 

 

 

 

 

attach a separate sheet.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO. OF MONTHS LIVED

 

 

 

 

 

 

 

FIRST AND LAST NAME

 

 

 

 

 

 

 

 

 

 

 

SOCIAL SECURITY NO.

RELATIONSHIP

 

IN YOUR HOME IN 2012

 

 

 

 

 

DependentsA:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b Enter dependents listed above who were not claimed on your federal return due to education credits:

 

 

 

 

 

 

 

A2

Enter total number of persons listed in A1 here and on the front of this form, box 10

 

TOTAL

 

A2

 

 

 

 

 

A3

a Enter the names of the dependents listed above who do not qualify as your dependent on your federal return:

 

 

 

 

 

 

PART

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A4

List qualifying parents and grandparents. If more space is needed, attach a separate sheet.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You cannot list the same person here and also on line A1. For information on who is a

 

 

 

 

 

 

 

 

 

 

 

 

qualifying parent or grandparent, see page 5 of the instructions.

 

 

 

 

 

 

 

 

NO. OF MONTHS LIVED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRST AND LAST NAME

 

 

 

 

 

 

 

 

 

 

 

SOCIAL SECURITY NO.

RELATIONSHIP

 

IN YOUR HOME IN 2012

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A5

Enter total number of persons listed in A4 here and on the front of this form, box 11

 

TOTAL

 

A5

 

 

 

 

 

B6

Dates of Arizona residency: From

 

M

 

M

 

D

 

D

 

Y Y

 

Y Y

 

to

 

M M

 

D D

 

Y Y Y

 

Y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2012 FEDERAL

 

2012 ARIZONA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Income

 

List other state(s) of residency:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount from Federal Return

 

Amount Only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B8

............................................................................................................................................Interest

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B8

 

 

00

 

 

00

 

 

 

B7

Wages, salaries, tips, etc

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B7

 

 

00

 

 

00

 

 

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B9

Dividends

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B9

 

 

00

 

 

00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of

B10

Arizona income tax refunds

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B10

 

 

00

 

 

00

 

 

B11

Alimony received

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B11

 

 

00

 

 

00

 

 

Percent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B13

.....................................................................................Gains (or losses) from federal Schedule D

 

 

 

 

 

 

 

B13

 

 

00

 

 

00

 

 

 

B12

Business income (or loss) from federal Schedule C

 

 

 

 

 

 

 

B12

 

 

00

 

 

00

 

 

Arizona

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B14

Rents, royalties, partnerships, estates, trusts, small business corporations from federal Schedule E.

B14

 

 

00

 

 

00

 

 

 

 

 

 

 

 

 

 

B15

Other income reported on your federal return

 

 

 

 

 

 

 

B15

 

 

00

 

 

00

 

 

B:

B16

Total income: Add lines B7 through B15

 

 

 

 

 

 

 

B16

 

 

00

 

 

00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

00

 

 

00

 

 

PART

B17

Federal adjustments. Attach your own schedule

 

 

 

 

 

 

 

B17

 

 

 

 

 

 

B18

Federal adjusted gross income: Subtract line B17 from line B16 in the FEDERAL column

 

B18

 

 

00

 

 

 

 

 

 

B19

Arizona income: Subtract line B17 from line B16 in the ARIZONA column. Enter here and on the front of this form, line 15

 

B19

 

00

 

 

 

B20

Arizona percentage: Divide line B19 by line B18, and enter the result (not over 100%)

 

 

 

 

B20

%

 

PARTC: Additions

C21

I.R.C. §179 expense in excess of allowable amount. Also see the instructions for line D34

 

 

 

 

C21

 

00

 

C22

Total depreciation included in Arizona gross income

 

 

 

 

 

 

 

 

 

 

 

 

C22

 

00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C23

Other additions to income: See instructions and attach your own schedule

 

 

 

 

 

 

 

 

 

 

 

C23

 

00

 

 

 

C24

Total: Add lines C21 through C23.

 

Enter here and on the front of this form on line 16

..................................................................

 

 

 

 

 

 

 

 

 

 

C24

 

00

 

 

Income

D25

Exemption: Age 65 or over. Multiply the number in box 8, page 1, by $2,100

 

 

 

 

 

 

 

D25

 

 

00

 

 

 

 

 

D27

.........................................Exemption: Dependents. Multiply the number in box 10, page 1, by $2,300

 

 

 

 

 

 

 

D27

 

 

00

 

 

 

 

 

 

D26

Exemption: Blind. Multiply the number in box 9, page 1, by $1,500

 

 

 

 

 

 

 

D26

 

 

00

 

 

 

 

 

from

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D28

Exemption: Qualifying parents and grandparents. Multiply the number in box 11, page 1, by $10,000 .

 

D28

 

 

00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Subtractions

D29

Total exemptions: Add lines D25 through D28

 

 

 

 

 

 

 

D29

 

 

00

 

 

 

 

 

D30

Multiply line D29 by the percentage on line B20, and enter the result

 

 

 

 

 

 

 

 

 

 

 

 

D30

 

00

 

 

D31

Interest on U.S. obligations such as U.S. savings bonds and treasury bills included in the ARIZONA column

 

D31

 

00

 

 

D32

Arizona state lottery winnings included on line B15 in the ARIZONA column (up to $5,000 only)

 

 

 

 

D32

 

00

 

D:

D33

U.S. Social Security or Railroad Retirement Act benefits included in your ARIZONA income

 

 

 

 

D33

 

00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D34

Adjustment for I.R.C. §179 expense not allowed

 

 

 

 

 

 

 

 

 

 

 

 

D34

 

00

 

PART

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D35

Other subtractions from income: See instructions and attach your own schedule

 

 

 

 

 

 

 

 

 

 

 

 

D35

 

00

 

 

D36

Total: Add lines D30 through D35.

 

Enter here and on the front of this form, line 17

 

 

 

 

 

 

 

 

 

 

 

D36

 

00

E37 Last name(s) used in prior years if different from name(s) used in current year:

HERE

 

I have read this return and any attachments with it. Under penalties of perjury, I declare that to the best of my knowledge and belief, they are

 

 

true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

 

 

 

 

SIGN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YOUR SIGNATURE

 

 

 

 

 

DATE

 

OCCUPATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPOUSE’S SIGNATURE

 

 

 

 

 

DATE

 

SPOUSE’S OCCUPATION

 

 

PLEASE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAID PREPARER’S SIGNATURE

 

DATE

 

FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

PAID PREPARER’S TIN

 

PAID PREPARER’S ADDRESS

 

 

 

 

 

PAID PREPARER’S PHONE NO.

 

If you are sending a payment with this return, mail to Arizona Department of Revenue, PO Box 52016, Phoenix, AZ, 85072-2016.

If you are expecting a refund or owe no tax, or owe tax but are not sending a payment, mail to Arizona Department of Revenue, PO Box 52138, Phoenix, AZ, 85072-2138.

ADOR 10149 (12)

AZ Form 140PY (2012)

Page 2 of 2

Form Breakdown

Fact Name Fact Description
Form Purpose The Arizona 140PY form is used for filing a part-year resident personal income tax return.
Governing Law This form is governed by the Arizona Revised Statutes, Title 43, which covers taxation.
Eligibility Individuals who lived in Arizona for only part of the tax year can use this form.
Filing Status Options Taxpayers can choose from several filing statuses: single, married filing jointly, married filing separately, or head of household.
Exemptions Taxpayers can claim exemptions for age, blindness, and dependents on this form.
Income Reporting Taxpayers must report their federal adjusted gross income and any Arizona income.
Tax Calculation Tax is computed using specified tax tables, and various credits can be applied to reduce the tax owed.
Payment Instructions Payments should be mailed to the Arizona Department of Revenue at specified addresses based on the filing situation.
Refund Options Taxpayers can opt for direct deposit of refunds, including the option for foreign accounts.