
ADOR 91-5380f (09)
Individual Amended Income Tax Return
ARIZONA FORM
140X
88
81 80
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
ONE STAPLE ONLY IN UPPER LEFT CORNER. NO TAPE.
Check box to indicate both fi ling and residency status:
4 Married fi ling joint return ........................................................... 4
5 Head of household
. ►
NAME OF QUALIFYING CHILD OR DEPENDENT
5
6 Married fi ling separate return: Enter spouse’s name and
Social Security No. above
..................................................................► 6
7 Single ........................................................................................ 7
8 Resident .................................................................................... 8
9 Nonresident .............................................................................. 9 Original Form Filed: (Check only one)
10 Part-year resident ..................................................................... 10 1Form 140...................................................................... 1
11 Part-year resident active military .............................................. 11 2 Form 140A ................................................................... 2
12 Nonresident active military ........................................................ 12 3 Form 140EZ ................................................................. 3
13 Age 65 or over: Enter the number claimed ................................... 13 4 Form 140NR ................................................................ 4
14 Blind: Enter the number claimed ................................................... 14 5 Form 140PY ................................................................. 5
15 Dependents: Enter the number claimed ....................................... 15
If 140NR or 140PY, enter corrected percentage of
16 Qualifying parents or ancestors ................................................ 16
Arizona residency ..........................
17 Federal adjusted gross income ................................................................................... 17
18 Form 140NR and 140PY fi lers only: Enter Arizona gross income ................................... 18
19 Additions to income .................................................................................................... 19
20 Subtotal: Form 140, 140A, 140EZ fi lers: Add lines 17 and line 19. Form 140NR or
140PY fi lers: Add lines 18 and 19
.................................................................................... 20
21 Subtractions from income ........................................................................................... 21
22 Arizona adjusted gross income: Subtract line 21 from line 20 ........................................ 22
23 Deductions (itemized or standard) .............................................................................. 23
24 Personal exemptions .................................................................................................. 24
25 Arizona taxable income: Subtract lines 23 and 24 from line 22 ........................................ 25
26 Tax from tax table: Table X or Y (140, 140NR or 140PY) Optional Table (140, 140A or 140EZ) ............................ 26
27 Tax from recapture of credits from Arizona Form 301, Part II ..................................... 27
28 Subtotal of tax: Add lines 26 and 27, column (c) ........................................................................................................................... 28
29 Clean Elections Fund Tax Reduction claimed on original return ................................ 29
30 Reduced tax: Subtract line 29 from line 28, column (c) .................................................................................................................. 30
31 Family income tax credit ............................................................................................. 31
32 Credits from Arizona Form 301 or Forms 310, 321, 322 or 323 ................................. 32
33 Credit type: Enter form number of each credit claimed .........................
33
34 Subtract lines 31 and 32 from line 30 .............................................................................................................................................. 34
35 Clean Elections Fund Tax Credit. See instructions ....................................................... 35
36 Balance of tax: Subtract line 35 from line 34. If line 35 is more than line 34, enter “zero” ................................................................... 36
37 Payments (withholding, estimated, or extension) ....................................................... 37
38 Increased Excise Tax Credit ....................................................................................... 38
39 Property Tax Credit ..................................................................................................... 39
40 Other refundable credits ........................................................40A1329 40A2330 40
41 Payment with original return plus all payments after it was fi led ............................................................................................. 41
42 Total payments and refundable credits: Add lines 37 through 41, column (c) ........................................................................ 42
43 Overpayment from original return or as later adjusted. See instructions ................................................................................... 43
44 Balance of credits: Subtract line 43 from line 42 .......................................................................................................................... 44
45 REFUND/CREDIT DUE: If line 36 is less than line 44, subtract line 36 from line 44, and enter amount of refund/credit ........................ 45
46 Amount of line 45 to be applied to 2010 estimated tax. If zero, enter “0” ............................................................................... 46
47 AMOUNT OWED: If line 36 is more than line 44, subtract line 44 from line 36, and enter the amount owed.
Payment enclosed. 47
48 Check box 48 if this amended return is the result of a net operating loss, and enter the year the loss was incurred ......48
YY02
97
86
ORIGINAL AMOUNT AMOUNT TO ADD CORRECTED
REPORTED OR SUBTRACT AMOUNT
(a) (b) (c)
Filing StatusResidency
DO NOT ATTACH PAYMENT. Attach W-2 as last page of the return.
Exemptions
Your First Name and Initial Last Name Your Social Security No.
1
Spouse’s First Name and Initial (if box 4 or 6 checked) Last Name Spouse’s Social Security No.
1
Present 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 Offi ce State Zip Code
3
ORIGINAL THIS
RETURN RETURN
IMPORTANT: You must enter an amount in columns (a), (b), and (c) for lines 17
and/or 18, lines 19 through 25, lines 27, 31, 32, 35, and lines 37 through 40.
FOR
CALENDAR YEAR
20
YY
OR FISCAL YEAR BEGINNING
MMDDYYYY
AND ENDING
MMDDYYYY
.
66
You must
enter your
SSN(s).
82 99
REVENUE USE ONLY