Arizona Form 140 - Resident Personal Income Tax Return

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Arizona Form
FOR CALENDAR YEAR
Resident Personal Income Tax Return
2016
140
Check box 82F
M M D D
2 0 1 6
M M D D
2 0
Y Y
82F
OR FISCAL YEAR BEGINNING
AND ENDING
.
66F
if filing under extension
Your First Name and Middle Initial
Last Name
Your Social Security Number
Enter
1
your
Spouse’s First Name and Middle Initial (if box 4 or 6 checked)
Last Name
Spouse’s Social Security No.
SSN(s).
1
Current Home Address - number and street, rural route
Apt. No.
Daytime Phone (with area code)
94
2
City, Town or Post Office
State
ZIP Code
Last Names Used in Last Four Prior Year(s) (if different)
3
97
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
4
Married filing joint return
88
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 Number above.
7
Single
 Enter the number claimed. Do not put a check mark.
8
Age 65 or over (you and/or spouse)
If completing lines 8
81 PM
80 RCVD
9
Blind (you and/or spouse)
through 11, also complete
10
Dependents:
Do not include self or spouse.
lines 38 through 41.
11
Qualifying parents and grandparents
(Box 10): Dependent Information: Children and other dependents. For more space, (check)
and complete page 3.
(a)
(b)
(c)
(d)
(e)
(f)
NO. OF MONTHS
FIRST AND LAST NAME
SOCIAL SECURITY NO.
RELATIONSHIP
if this person
if you did not claim
LIVED IN YOUR
did not qualify as a
this person on your
(Do not list yourself or spouse.)
dependent on your
federal return due to
HOME IN 2016
federal return
educational credits
10
a
10
b
10
c
(Box 11): Qualifying parents and grandparents. See instructions. For more space, (check)
and complete page 3.
(a)
(b)
(c)
(d)
(e)
(f)
FIRST AND LAST NAME
SOCIAL SECURITY NO.
RELATIONSHIP
NO. OF MONTHS
if
if
LIVED IN YOUR
(Do not list yourself or spouse.)
age 65 or over
died in 2016
HOME IN 2016
11
a
11
b
00
12 Federal adjusted gross income (from your federal return) ................................................................................... 12
00
13 Non-Arizona municipal interest.................................................................................................................................... 13
00
14 Partnership Income adjustment:
......................................................................................................... 14
See instructions
00
15 Total federal depreciation ............................................................................................................................................ 15
00
16 Other Additions to Income:
...................................................................... 16
See instructions and include your own schedule
00
17 Subtotal:
....................................................................................................... 17
Add lines 12 through 16 and enter the total
00
18 Total net capital gain or (loss):
..................................................................... 18
See instructions
00
19 Total net short-term capital gain or
loss
:
.................................................... 19
(
)
See instructions
00
20 Total net long-term capital gain or (loss):
20
Enter the amount from your worksheet, line 14, col. (a)
21 Net long-term capital gain from assets acquired after December 31, 2011.
Enter the
00
............................................................................... 21
amount from your worksheet, line 14, col. (c)
00
22 Multiply line 21 by 25% (.25) and enter the result ....................................................................................................... 22
00
23 Net capital gain derived from investment in qualified small business.......................................................................... 23
00
24 Recalculated Arizona depreciation .............................................................................................................................. 24
00
25 Partnership Income adjustment:
........................................................................................................ 25
See instructions
00
26 Adjustment for I.R.C. §179 expense not allowed ........................................................................................................ 26
00
27 Interest on U.S. obligations such as U.S. savings bonds and treasury bills ................................................................ 27
00
28 Exclusion for federal, Arizona state or local government pensions (up to $2,500 per taxpayer) ................................. 28
00
29 Arizona state lottery winnings included as income on your federal return (up to $5,000 only) ................................... 29
00
30 U.S. Social Security or Railroad Retirement Act benefits included as income on your federal return
30
(taxable amount)
00
31 Certain wages of American Indians ............................................................................................................................. 31
00
32 Pay received for active service as a member of the reserves, national guard or the U.S. armed forces .................... 32
00
33 Net operating loss adjustment:
................................................................ 33
See instructions before you make an entry here
00
34 Contributions to 529 College Savings Plans ............................................................................................................... 34
00
35 Other Subtractions from Income:
............................................................ 35
See instructions and include your own schedule
00
36 Subtract lines 22 through 35 from line 17 and enter the difference ............................................................................. 36
AZ Form 140 (2016)
ADOR 10413 (16)
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