
PLEASE BE SURE TO SIGN THE RETURN ON THE REVERSE SIDE OF THIS PAGE.
Enter
your
SSN(s).
81
PM
80
RCVD
88
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
ONE STAPLE. NO TAPE.
Enter the number claimed. Do not put a check mark.
STOP
taxable incomemust
8
9
10 do not include self or spouse
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18 Arizona adjusted gross income: 18
19 19
20 20
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22 22
23 23
24 Balance of tax: 24
25 25
26 26
27 27
28 28
29 Total payments/credits: 29
30 TAX DUE: 30
31 OVERPAYMENT: 31
32 - 41 Voluntary Gifts to:
42
421
422
423
424
425
43 43
44 REFUND: 44
98
Direct Deposit of Refund:Check box 44Aforeign account44A
C
S
45 AMOUNT OWED:
include SSN on payment 45
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2013
Place any required federal and AZ schedules or other documents after Form 140A page 2; staple to upper left corner.
1
1
94
2
3
82F
Check box 82F if filing under extension
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Arizona Form 140A Resident Personal Income Tax Return (Short Form)