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Arizona Form 140A Resident Personal Income Tax Return (Short Form)

STOP If your Arizona taxable income is $50,000 or more, you must use Arizona Form 140.

FOR

CALENDAR YEAR

2013

ONE STAPLE. NO TAPE.

or other documents after Form 140A page 2; staple to upper left corner.

	82F			Check box 82F if filing under extension
	Your		First Name and Middle Initial					Last Name				Enter			Your Social Security No.
												Enter
												your

	Spouse’s First Name and Middle Initial (if box 4 or 6 checked)							Last Name							Spouse’s Social Security No.
								Last Name				SSN(s)		.	Spouse’s Social Security No.
												SSN(s)		.

	Current Home Address - number and street, rural route								Apt. No.					Phone (with area code)
	Current Home Address - number and street, rural route								Apt. No.			Daytime		Phone (with area code)

	City, Town or Post Office						State	ZIP Code				94
												94
										Last Names			Used in Prior Years

STATUS			4			Married filing joint return				REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
										REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
										88
FILING			5			Head of household – Enter name of qualifying child or dependent on next line:


			6
						Married filing separate return. Enter spouse’s name and Social Security No. above.

			7			Single
			7			Single

ExEMPTIONS					 Enter the number claimed. Do not put a check mark.
ExEMPTIONS			8			Age 65 or over (you and/or spouse)
			9			Blind (you and/or spouse)					PM						RCVD
			9			Blind (you and/or spouse)				81	PM					80	RCVD
		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			Exemption – Age 65 or over: Multiply the number in box 8 by $2,100												13			00
14			Exemption – Blind: Multiply the number in box 9 by $1,500												14			00
15			Exemption – Dependents: Multiply the number in box 10 by $2,300												15			00
16			Exemption – Qualifying parents and grandparents: Multiply the number in box 11 by $10,000												16			00
17			Total subtractions: Add lines 13 through 16				.....................................................................................................................								17			00
18			Arizona adjusted gross income: Subtract line 17 from line 12												18			00
19			Standard deduction: If you checked filing status box 4 or 5, enter $9,883. If you checked box 6 or 7, enter $4,945.												19			00
20			Personal exemptions. See pages 6 and 7 of the instructions												20			00
21			Arizona taxable income: Subtract lines 19 and 20 from line 18. If less than zero, enter zero. If $50,000 or more, use Form 140 .												21			00
22			Amount of tax from Optional Tax Tables												22			00
23			Family income tax credit (from worksheet on page 8 of the instructions)												23			00
24			Balance of tax: Subtract line 23 from line 22. If less than zero, enter zero												24			00
25			Arizona income tax withheld during 2013				.....................................................................................................................								25			00
26			2013 Arizona extension payment (Form 204)												26			00
27			Increased Excise Tax Credit (from worksheet on page 9 of the instructions)												27			00
28			Property Tax Credit (from Form 140PTC)												28			00
29			Total payments/credits: Add lines 25 through 28												29			00
30			TAX DUE: If line 24 is larger than line 29, subtract line 29 from line 24, and enter amount of tax due. Skip line 31												30			00
31			OVERPAYMENT: If line 29 is larger than line 24, subtract line 24 from line 29, and enter the amount of overpayment												31			00

and AZ schedules

32 - 41 Voluntary Gifts to:
Solutions Teams Assigned to School..	32
Child Abuse Prevention	34
I Didn’t Pay Enough Fund	36
Neighbors Helping Neighbors	38
Veterans’ Donations Fund	40

42Voluntary Political Gift (check only one):

Arizona Wildlife	33
Domestic Violence Shelter	35
National Guard Relief Fund	37
Special Olympics	39
Political Gift	41

Place any required federal

	421Americans Elect 422Democratic 423Green 424Libertarian 425Republican
43	Total voluntary gifts: Add lines 32 through 41						43	00
44	REFUND: Subtract line 43 from line 31.			If less than zero, enter amount owed on line 45			44	00
	Direct Deposit of Refund: Check box 44A if your deposit will be ultimately placed in a foreign account; see instructions. 44A
		ROUTING NUMBER			ACCOUNT NUMBER	C Checking or
	98					C Checking or
45	98					S Savings	45	00
45	AMOUNT OWED: Add lines 30 and		43. Make check payable to Arizona Department of Revenue; include SSN on payment				45	00

PLEASE BE SURE TO SIGN THE RETURN ON THE REVERSE SIDE OF THIS PAGE.

ADOR 10414 (13)

Your Name (as shown on page 1)

Your Social Security No.

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

A1 List children and other dependents.		If more space is needed, attach a separate sheet.
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 2013

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

TOTAL A2

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

page 6 of the instructions.

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

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 2013

A5 Enter total number of persons listed in A4 here and on the front of this form, box 11

TOTAL

PLEASE SIGN 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.


	YOUR SIGNATURE		DATE	OCCUPATION

	SPOUSE’S SIGNATURE		DATE	SPOUSE’S OCCUPATION

	PAID PREPARER’S SIGNATURE	DATE	FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED)

PAID PREPARER’S STREET ADDRESSPAID PREPARER’S TIN


			(		)
PAID PREPARER’S CITY	STATE	ZIP CODE		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 10414 (13)

AZ Form 140A (2013)

Page 2 of 2

Question	Answer
Form Name	Arizona Form 140A
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names

Arizona Form 140A – Fill Out and Use This PDF

Arizona Form 140A PDF Details

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