Arizona Form 140ptc - Property Tax Refund (Credit) Claim

Arizona Form

FOR CALENDAR YEAR

Property Tax Refund (Credit) Claim

2016

140PTC

You must file this form, or Arizona Form 204, by April 18, 2017.

Check box 82F if filing under extension

Check box 95 if amending claim for tax year 2016

82F

Your First Name and Middle Initial

Last Name

Your Social Security Number

Enter

your

Spouse’s First Name and Middle Initial (if a joint claim)

Last Name

Spouse’s Social Security No.

SSN(s).

Current Home Address - number and street, rural route

Apt. No.

Daytime Phone (with area code)

City, Town or Post Office

State

ZIP Code

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

Your Date of Birth

M M D D Y Y Y Y

QUALIFICATIONS FOR CREDIT

(Check the boxes that apply):

4 On December 31, 2016, were you renting or did you own? If you own a

Rent Own

 

mobile home but rent the space, check “Rent”.................................................... 4

81 PM

80 RCVD

5 Were you an Arizona resident for all of 2016?

Yes

 

If “No”, STOP. You do not qualify ....................................................................... 5

6 Did you pay property taxes on your home, pay rent, or pay a combination of

both in 2016? See instructions for qualifications.

 

If “No”, STOP. You do not qualify ....................................................................... 6

7 Is this the only Property Tax Refund being claimed in your household?

 

If “No”, STOP. You do not qualify ....................................................................... 7

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8 Were you age 65 or older in 2016? Enter your birth date in box 79 above ........ 8

9 Did you receive Title 16, SSI payments in 2016? If “Yes”, include proof.

 

If you answered “No” to both 8 and 9, STOP. You do not qualify. ....................... 9

INCOME

10 Total Household Income: Enter the amount from page 2, Part 1, line J, column 4 ........................................................ 10

CREDIT

11 a If you lived alone, enter the amount of credit from page 2, Part 1, Schedule 1, and



check the box .............................................................................................................................. 11a

Schedule 1

b If you lived with your spouse or one or more other persons, enter the amount of



credit from page 2, Part 1, Schedule 2, and check the box ........................................................11b

Schedule 2 11

12 If you owned your property, enter property taxes actually paid during 2016. Include proof of

property taxes paid during 2016 .................................................................................................................................. 12

13 If you rented, enter property taxes paid by your landlord on your portion of rents. Include Form 201 ........................... 13

14 Total property taxes paid in 2016. Add lines 12 and 13 .................................................................................................. 14

15 Amount of Property Tax Credit: Enter the smaller of line 11 or line 14 ....................................................................... 15

16 If you have been claimed as a dependent on anyone else’s tax return, complete the following:

Name Of Taxpayer Who Claimed You

Social Security Number

Address:

If you are not claimed as a dependent on anyone else’s tax return, turn the form over and complete Part 2.

If someone else claims you as a dependent, skip lines 17 and 18, and complete line 19.

17 Credit for increased excise taxes from Form 140PTC, page 2, Part 2, line 6 .............................................................. 17

18 Enter the number from page 2, Part 2, line 2, here ...................................................................................... 18

19 Total Credit: Add lines 15 and 17, and enter the total. See page 5 of the instructions if you have to file

Arizona Form 140 or Form 140A .................................................................................................................................... 19



Direct Deposit of Refund: Check box

if your deposit will be ultimately placed in a foreign account; see instructions.

ROUTING NUMBER

ACCOUNT NUMBER



Checking or



Savings

If this is your first claim for 2016, STOP HERE AND GO TO THE SIGNATURE BOX ON PAGE 2. If

this is an amended claim, complete lines 20 through 22, and check the box at the top of the form.

AMENDED

20 Enter the amount from line 5 of the worksheet on page 6 of the instructions ................................................................. 20

21 Additional refund: If line 19 is larger than line 20, subtract line 20 from line 19 ............................................................. 21

22 Amount to pay: If line 19 is less than line 20, subtract line 19 from line 20. Make check payable to

Arizona Department of Revenue; write your SSN on payment, and include your payment with Form 140PTC ............. 22

Continued on page 2 

ADOR 10567 (16)