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ARIZONA FORM										Resident Personal Income Tax Return																																										FOR
		140								Resident Personal Income Tax Return																																										CALENDAR YEAR
		140							OR FISCAL YEAR BEGINNING						M		M		D			D			Y		Y		Y	Y	AND ENDING				M	M	D		D	Y			Y		Y	Y			.		66	2012

	82F						Check box 82F if filing under extension

	Your First Name and Middle Initial																										Last Name													Enter						Your Social Security No.
		1																																						Enter
		1
	Spouse’s First Name and Middle Initial (if box 4 or 6 checked)																										Last Name													your						Spouse’s Social Security No.
																											Last Name																			Spouse’s Social Security No.
																																								SSN(s)					.
		1																																						SSN(s)					.
		1
	Current Home Address - number and street, rural route																	Apt. No. Daytime Phone (with area code)																						Home Phone (with area code)
		2																																							94
	City, Town or Post Office										State Zip Code
	City, Town or Post Office										State Zip Code
		3
corner.leftupper			STATUSFILING	4				Married filing joint return																												REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
																																				REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

				5				Head of household			NAME OF QUALIFYING CHILD OR DEPENDENT
				5				Head of household
				6
								Married filing separate return. Enter spouse’s name and Social Security No. above.

				7				Single
				7				Single
staple2;pageto
			EXEMPTIONS					Enter the number claimed. Do not put a check mark.
			EXEMPTIONS	8				Age 65 or over (you and/or spouse)																												88
				8				Age 65 or over (you and/or spouse)																												88
				9				Blind (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.																												81															80

140			12		Federal adjusted gross income (from your federal return)															.....................................................................................................																															12		00
140			13		Additions to income (from page 2, line B12)																																														13		00
Form			13		Additions to income (from page 2, line B12)																																														13		00
Form			14		Subtractions from income (from page 2, line C17 or line C30)																																														14		00
			14																																																14		00
after			15		Arizona adjusted gross income. Add lines 12 and 13 then subtract line 14																																														15		00
			15																																																15		00
documents			16		Deductions: Check box and enter amount. See instructions, pages 14 and 15...																											16I ITEMIZED 16S									STANDARD										16		00
documents			19		......................................................Compute the tax using amount on line 18 and Tax Table X, Y or Optional Tax Tables																																														19		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
other
other			20		Tax from recapture of credits from Arizona Form 301, Part II, line 35																																														20		00
or			21		Subtotal of tax: Add lines 19 and 20																																														21		00
or			22		Family income tax credit (from worksheet on page 16 of instructions)																																														22		00
schedules			22																																																22		00
schedules			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
			23																																								23	00
			24		Credit type: Enter form number of each credit claimed																					24			3				3			3							3
			24		Credit type: Enter form number of each credit claimed											..............										24			3				3			3							3
			25																																																25		00
AZ			25		Clean Elections Fund Tax Credit for donations made prior to August 2, 2012 (from worksheet on page 18 of the instructions)																																														25		00
AZ			26		Balance of tax: Subtract lines 22, 23 and 25 from line 21.																																														26		00
and			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
and			27		Arizona income tax withheld during 2012																																														27		00
federal			27		Arizona income tax withheld during 2012																																														27		00
federal			28		Arizona estimated tax payments for 2012																																														28		00
required			29		2012 Arizona extension payment (Form 204)																																														29		00
required			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
any			32		Other refundable credits: Check the box(es) and enter the amount																												321 Form 308-I 322										Form 342								32		00
any			33		Total payments/refundable credits: Add lines 27 through 32																																														33		00
Place			33		Total payments/refundable credits: Add lines 27 through 32																																														33		00
Place			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
			34																																			...........					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
			35																																													35		00
		36			Amount of line 35 to be applied to 2013 estimated tax																																														36		00
TAPE.		37			Balance of overpayment: Subtract line 36 from line 35																																														37		00
TAPE.			38 - 47 Voluntary Gifts to:
			38 - 47 Voluntary Gifts to:
NO					Aid to Education						38										00				Arizona Wildlife											39											00
NO					Child Abuse Prevention						40										00				Domestic Violence Shelter											41											00
					Child Abuse Prevention						40										00				Domestic Violence Shelter											41											00
HERE.					I Didn’t Pay Enough Fund						42										00		National Guard Relief Fund													43											00
					Neighbors Helping Neighbors						44										00				Special Olympics											45											00
PAYMENT					Veterans’ Donations Fund						46										00				Political Gift											47											00
PAYMENT		50			Check applicable boxes 501....					Annualized/Other						502				Farmer or Fisherman 503													Form 221 attached 504									MSA Penalty
		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
STAPLE		51			Total of lines 38 through 47 and 49																																														51	00
STAPLE		52			REFUND: Subtract line 51 from line 37.							If less than zero, enter amount owed on line 53																																							52	00
		52			REFUND: Subtract line 51 from line 37.							If less than zero, enter amount owed on line 53																																							52	00
					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																								C			Checking or
					98																																C			Checking or
					98																																S			Savings
		53			AMOUNT OWED: Add lines 34 and 51.							Make check payable to Arizona Department of Revenue; include SSN on payment.																																					53	00

ADOR 10413 (12)

Your Name (as shown on page 1)

Your Social Security No.

PART A: Dependents, Qualifying Parents and Grandparents - do not list yourself or spouse

If completing Part A, also complete Part C, lines C15 and/or C16 and C17.
A1 List children and other dependents. 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

A2 Enter total number of persons listed in A1 here and on the front of this form, box 10; also complete Part C below... TOTAL

A3 a Enter the names of the dependents listed above who do not qualify as your dependent on your federal return:

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

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 6 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

PART B: Additions to Income

B6	Non-Arizona municipal interest		B6
B7	Ordinary income portion of lump-sum distributions excluded on your federal return		B7
B8	Total federal depreciation. Also see the instructions for line C22		B8
B9	Medical savings account (MSA) distributions. See page 7 of the instructions		B9
B10	I.R.C. §179 expense in excess of allowable amount. Also see the instructions for line C26	B10
B11	Other additions to income. See instructions and attach your own schedule	B11
B12	Total: Add lines B6 through B11. Enter here and on the front of this form, line 13	B12

PART C: Subtractions From Income

C13

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

C13

C14

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

C14

C15

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

C15

C16

Exemption: Qualifying parents and grandparents. Multiply the number in

box 11, page 1, by $10,000

C16

C17

Total exemptions: Add lines C13 through C16.

If you have no other subtractions from

income, skip lines C18 through C30 and enter the amount on line C17 on Form 140, Page 1, line 14

C17

C18

Interest on U.S. obligations such as U.S. savings bonds and treasury bills

C18

C19

Exclusion for federal, Arizona state or local government pensions (up to $2,500 per taxpayer)

C19

C20

Arizona state lottery winnings included as income on your federal return (up to $5,000 only)

C20

C21

U.S. Social Security or Railroad Retirement Act benefits included as income on your federal return (the taxable amount) .

C21

C22

Recalculated Arizona depreciation

C22

C23

Certain wages of American Indians

C23

C24

Income tax refund from other states. See instructions

C24

C25

Deposits and employer contributions into MSAs. See page 11 of the instructions

C25

C26

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

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

C26

C27

Pay received for active service as a member of the reserves, national guard or the U.S. armed forces

C27

C28

Net operating loss adjustment. See instructions before you enter any amount here

C28

C29

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

C29

C30

Total: Add lines C17 through C29. Enter here and on the front of this form, line 14

C30

Part D: Last Name(s) Used in Prior Years – if different from name(s) used in current year

D31

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

PLEASE

SPOUSE’S SIGNATURE

DATE

SPOUSE’S OCCUPATION

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 10413 (12)

AZ Form 140 (2012)

Page 2 of 2

Question	Answer
Form Name	Arizona Form 140
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	arizona form 204, 2012, C17, preparer

Arizona Form 140 – Fill Out and Use This PDF

Arizona Form 140 PDF Details

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