
88
81 80
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
NO TAPE.
Place any required federal and AZ schedules or other documents after Form 140 page 2; staple to upper left corner.
OR FISCAL YEAR BEGINNING
M M D D Y Y Y Y
AND ENDING
M M D D Y Y Y Y
.
66
Resident Personal Income Tax Return
ARIZONA FORM
140
Your First Name and Middle Initial Last Name Your Social Security No.
1
Spouse’s First Name and Middle Initial (if box 4 or 6 checked) Last Name Spouse’s Social Security No.
1
Current Home Address - number and street, rural route Apt. No. Daytime Phone (with area code) Home Phone (with area code)
94
2
City, Town or Post Office State Zip Code
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.
11
Qualifying parents and grandparents. From page 2, line A5.
12 Federal adjusted gross income (from your federal return) ..................................................................................................... 12 00
13 Additions to income (from page 2, line B12) .......................................................................................................................... 13 00
14 Subtractions from income (from page 2, line C17 or line C30) ............................................................................................................... 14 00
15 Arizona adjusted gross income. Add lines 12 and 13 then subtract line 14 ......................................................................... 15 00
16 Deductions: Check box and enter amount. See instructions, pages 14 and 15 ... 16I
ITEMIZED 16S
STANDARD 16 00
17 Personal exemptions. See page 15 of the instructions ........................................................................................................... 17 00
18 Arizona taxable income: Subtract lines 16 and 17 from line 15. If less than zero, enter zero ...................................................... 18 00
19 Compute the tax using amount on line 18 and Tax Table X, Y or Optional Tax Tables ...................................................... 19 00
20 Tax from recapture of credits from Arizona Form 301, Part II, line 35 ............................................................................... 20 00
21 Subtotal of tax: Add lines 19 and 20 ..................................................................................................................................... 21 00
22 Family income tax credit (from worksheet on page 16 of instructions) ...................................................................................... 22 00
23 Credits from Arizona Form 301, Part II, line 68, or Forms 310, 321, 322, and 323 if Form 301 is not required ................ 23 00
24 Credit type: Enter form number of each credit claimed ..............
24
3 3 3 3
25 Clean Elections Fund Tax Credit for donations made prior to August 2, 2012 (from worksheet on page 18 of the instructions) 25 00
26 Balance of tax: Subtract lines 22, 23 and 25 from line 21. If the sum of lines 22, 23 and 25 is more than line 21, enter zero ........... 26 00
27 Arizona income tax withheld during 2012 .......................................................................................................................... 27 00
28 Arizona estimated tax payments for 2012 ......................................................................................................................... 28 00
29 2012 Arizona extension payment (Form 204) .................................................................................................................... 29 00
30 Increased Excise Tax Credit (from Form 140PTC or worksheet on page 19 of the instructions) ................................................... 30 00
31 Property Tax Credit from Form 140PTC ............................................................................................................................ 31 00
32 Other refundable credits: Check the box(es) and enter the amount ......................... 321
Form 308-I 322
Form 342 32 00
33 Total payments/refundable credits: Add lines 27 through 32 ............................................................................................ 33 00
34 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 ........... 34 00
35 OVERPAYMENT: If line 33 is larger than line 26, subtract line 26 from line 33 and enter amount of overpayment ........................... 35 00
36 Amount of line 35 to be applied to 2013 estimated tax ...................................................................................................... 36 00
37 Balance of overpayment: Subtract line 36 from line 35 .......................................................................................................... 37 00
38 - 47 Voluntary Gifts to:
48 Voluntary Political Gift (check only one): 481
Americans Elect 482
Democratic 483
Green 484
Libertarian 485
Republican
49 Estimated payment penalty and MSA withdrawal penalty ................................................................................................. 49 00
50 Check applicable boxes .... 501Annualized/Other 502
Farmer or Fisherman 503
Form 221 attached 504
MSA Penalty
51 Total of lines 38 through 47 and 49 ................................................................................................................................... 51 00
52 REFUND: Subtract line 51 from line 37. If less than zero, enter amount owed on line 53 ............................................................. 52 00
98
C Checking or
S Savings
Direct Deposit of Refund: Check box 52A if your deposit will be ultimately placed in a foreign account; see instructions. 52A
ROUTING NUMBER ACCOUNT NUMBER
53 AMOUNT OWED: Add lines 34 and 51. Make check payable to Arizona Department of Revenue; include SSN on payment. 53 00
Aid to Education .................................
38 00
Arizona Wildlife ...................................
39 00
Child Abuse Prevention ......................
40 00
Domestic Violence Shelter .................
41 00
I Didn’t Pay Enough Fund...................
42 00
National Guard Relief Fund ................
43 00
Neighbors Helping Neighbors.............
44 00
Special Olympics ................................
45 00
Veterans’ Donations Fund ..................
46 00
Political Gift.........................................
47 00
3
FILING STATUS
EXEMPTIONS
FOR
CALENDAR YEAR
2012
ADOR 10413 (12)
82F
Check box 82F if filing under extension
Enter
your
SSN(s).
4
Married filing joint return
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
STAPLE PAYMENT HERE. NO TAPE.
Enter the number claimed. Do not put a check mark.