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ARIZONA FORM																																						FOR
ARIZONA FORM						Individual Amended Income Tax Return																													CALENDAR YEAR
	140X					Individual Amended Income Tax Return																															20		YY
				OR FISCAL YEAR BEGINNING				M	M	D	D		Y	Y	Y	Y	AND ENDING					M		M	D			D	Y		Y	Y	Y	. 66


Your First Name and Initial														Last Name																			Your Social Security No.
	1																										You must
	1																										enter your
Spouse’s First Name and Initial (if box 4 or 6 checked)														Last Name													enter your						Spouse’s Social Security No.
	1																										SSN(s).
	1
Present Home Address - number and street, rural route Apt. No.														Daytime Phone (with area code)													Home Phone (with area code)
	2																									94
	2																									94

City, Town or Post Ofﬁce						State	Zip Code														REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
	3													ORIGINAL				THIS
														ORIGINAL				THIS
	Check box to indicate both ﬁ ling and residency status:													RETURN RETURN
Status	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
	5	Head of household. ►												5
Filing	6		Married ﬁling separate return: Enter spouse’s name and																88
					..................................................................							► 6							88
			Social Security No. above									► 6
	7		Single											7					81														80
Residency	8		Resident											8					81														80

																																				97
	9		Nonresident											9					Original Form Filed: (Check only one)																	97
	9		Nonresident											9					Original Form Filed: (Check only one)
	10		Part-year resident									10							1Form 140																	1
	11		Part-year resident active military									11							2Form 140A																	2
	12		Nonresident active military									12							3Form 140EZ																	3
	12		Nonresident active military									12							3Form 140EZ																	3
Exemptions	13		Age 65 or over: Enter the number claimed									13							4Form 140NR							................................................................										4
	14		Blind: Enter the number claimed									14							5Form 140PY																	5
	15		Dependents: Enter the number claimed									15							If 140NR or 140PY, enter corrected percentage of
	15		Dependents: Enter the number claimed									15
	16		Qualifying parents or ancestors									16							..........................Arizona residency																86
			IMPORTANT: You must enter an amount in columns (a), (b), and (c) for lines 17																	ORIGINAL AMOUNT										AMOUNT TO ADD						CORRECTED
																					REPORTED									OR SUBTRACT							AMOUNT
			and/or 18, lines 19 through 25, lines 27, 31, 32, 35, and lines 37 through 40.																		REPORTED									OR SUBTRACT							AMOUNT
																							(a)									(b)						(c)
	17		Federal adjusted gross income																																17
	18		Form 140NR and 140PY ﬁ lers only: Enter Arizona gross income																																18
return.	19		Additions to income																																19
	20		Subtotal: Form 140, 140A, 140EZ ﬁlers: Add lines 17 and line 19.											Form 140NR or
			140PY ﬁlers: Add lines 18 and 19																																20
	21		Subtractions from income																																21
the	21		Subtractions from income																																21
the	22		Arizona adjusted gross income: Subtract line 21 from line 20																																22
of	22																																		22
of	23		Deductions (itemized or standard)																																23
page	23		Deductions (itemized or standard)																																23
	24		Personal exemptions																																24
	25		Arizona taxable income: Subtract lines 23 and 24 from line 22																																25
last	25																																		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
as	27																																		27
as	28		Subtotal of tax: Add lines 26 and 27, column (c)																																28
2	28		Subtotal of tax: Add lines 26 and 27, column (c)																																28
W-	29		Clean Elections Fund Tax Reduction claimed on original return																																29
W-
Attach	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
	32		Credits from Arizona Form 301 or Forms 310, 321, 322 or 323																																32
PAYMENT.	33		Credit type: Enter form number of each credit claimed											33
	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

ATTACH	38		Increased Excise Tax Credit																																38
	39		Property Tax Credit																																39
	40		Other refundable credits									40A1 329 40A2						330																	40
	41		Payment with original return plus all payments after it was ﬁled																																41
NOT	41																																		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
DO	43																																		43
DO	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			2 0 Y Y
ADOR 91-5380f (09)																																			REVENUE USE ONLY
																																			82	99

Your Name (as shown on page 1)

Your Social Security No.

PART I: Dependent Exemptions - do not list yourself or spouse as dependents

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

FIRST AND LAST NAME:	SOCIAL SECURITY NO.	RELATIONSHIP

NO. OF MONTHS LIVED IN YOUR HOME DURING THE TAXABLE YEAR

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

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

PART II: Qualifying Parents and Ancestors of Your Parents Exemptions (Arizona residents only)

List below qualifying parents and ancestors of your parents for which you are claiming an exemption. If more space is needed, attach a separate sheet. Do not list the same person here that you listed in Part I, above, as a dependent. For information on who is a qualifying parent or ancestor of your parents, see the instructions for the original return that you ﬁled.

FIRST AND LAST NAME:

SOCIAL SECURITY NO.

RELATIONSHIP

NO. OF MONTHS LIVED IN YOUR HOME DURING THE TAXABLE YEAR

PART III: Income, Deductions, and Credits

List the line reference from page 1 for which you are reporting a change then give the reason for each change. Attach any supporting documents required. If the change(s) pertain(s) to an IRS audit, please attach a copy of the agent’s report. If you ﬁled an amended federal return with the IRS (Form 1040X), please attach a copy and all supporting schedules.

Part IV: Name and Address on Original Return

If your name and address is the same on this amended return as it was on your original return, write “same” on the line below.

Name	Number and Street, R.R.	Apt. No.	City, Town or Post Ofﬁce State Zip Code

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 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 91-5380f (09)

Form 140X (2009)

Page 2 of 2

Question	Answer
Form Name	Arizona Form 140X
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	az 140, az 1099 form printable, printable arizona state tax forms, 2020 arizona printatble 140a tax form

Arizona Form 140X – Fill Out and Use This PDF

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