Arizona Form 140x - Individual Amended Income Tax Return - 2016

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Arizona Form
FOR CALENDAR YEAR
Individual Amended Income Tax Return
2016
140X
M M D D
2 0 1 6
M M D D Y Y Y Y
. 66
OR FISCAL YEAR BEGINNING
AND ENDING
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)
97
3
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
Check a box to indicate both filing and residency status:
88
4
Married filing joint return
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 check
8
Resident
9a
Nonresident
9b
Composite
13 Age 65 or over ..................................
81 PM
80 RCVD
10
Nonresident active military
14 Blind ..................................................
11
Part-year resident
15 Dependents ......................................
12
Part-year resident active military
16 Qualifying parents or grandparents ..
00
17 Federal adjusted gross income (from your federal return) ...................................................................................... 17
00
18 Nonresidents and part-year residents only: Enter Arizona gross income here.............................................................. 18
18a Arizona income ratio: If you checked box 9a, 10, 11 or 12, divide line 18 by line 17 and enter the result (not over 1.000) 18a
00
19 Additions to Income.
............................................................................................................................... 19
See instructions
00
20 Subtotal: Residents:
Nonresidents and part-year residents:
...................... 20
Add line 17 and line 19.
Add lines 18 and 19
00
21 Subtractions from Income.
..................................................................................................................... 21
See instructions
00
22 Total net capital gain or (loss):
.................................................................... 22
See instructions
00
23 Total net short-term capital gain or
loss
:
................................................... 23
(
)
See instructions
00
24 Total net long-term capital gain or (loss):
... 24
Enter the amount from your worksheet, line 14, col. (a)
00
25 Net long-term capital gain from assets acquired after December 31, 2011.
... 25
See instructions
00
26 Multiply line 25 by 25% (.25) and enter the result .......................................................................................................... 26
00
27 Net capital gain derived from investment in qualified small business............................................................................. 27
28 Reserved ........................................................................................................................................................................ 28
00
29 Contributions to 529 College Savings Plans .................................................................................................................. 29
00
30 Arizona adjusted gross income:
................... 30
Subtract line 21 and lines 26 through 29 from line 20, and enter the difference
00
I
S
31 Deductions: Check box and enter amount.
........................
ITEMIZED
STANDARD 31
See instructions
31
31
00
32 Personal exemptions:
............................................................................................................................. 32
See instructions
00
33 Arizona taxable income:
................................................... 33
Subtract lines 31 and 32 from line 30. If less than zero, enter zero
00
34 Tax from tax table:
Table X or Y (140, 140NR or 140PY)
Optional Table (140, 140A or 140EZ) ................... 34
00
35 Tax from recapture of credits from Arizona Form 301, Part 2, line 40 ............................................................................ 35
00
36 Subtotal of tax:
.................................................................................................................................. 36
Add lines 34 and 35
00
37 Family income tax credit (Arizona residents only) .......................................................................................................... 37
00
38 Credits from Arizona Form 301, Part 2, line 76 .............................................................................................................. 38
00
39 Balance of tax:
.................. 39
Subtract lines 37 and 38 from line 36. If the sum of lines 37 and 38 is more than line 36, enter zero
00
00
00
40 Withholding, Estimated, and Extension Payments
a
b
40c
Claim of Right
40
40
00
41 Increased Excise Tax Credit (Arizona residents only) .................................................................................................... 41
00
42 Property Tax Credit (Arizona residents only) .................................................................................................................. 42
00
43 Other refundable credits:
......................
1
308-I
2
342
3
349 43
Check the box(es) and enter the total amount
43
43
43
00
44 Payment with original return plus all payments after it was filed .................................................................................... 44
00
45 Total payments and refundable credits:
................................................................................. 45
Add lines 40 through 44
00
46 Overpayment from original return or as later adjusted.
.......................................................................... 46
See instructions
00
47 Balance of credits:
................................................................................................................. 47
Subtract line 46 from line 45
00
48 OVERPAYMENT:
.......................... 48
If line 39 is less than line 47, subtract line 39 from line 47 and enter amount of overpayment
00
49 Amount of line 48 to be applied to 2017 estimated tax. If zero, enter “0” ...................................................................... 49
00
50 REFUND:
......................................................... 50
Subtract line 49 from line 48. If less than zero, enter amount owed on line 51
A
A
Direct Deposit of Refund: Check box
if your deposit will be ultimately placed in a foreign account; see instructions.
50
50
ROUTING NUMBER
ACCOUNT NUMBER
C
Checking or
98
S
Savings
00
51 AMOUNT OWED:
................................ 51
If line 39 is more than line 47, subtract line 47 from line 39, and enter the amount owed
2
0
Y
Y
52 Check box 52 if this amended return is the result of a net operating loss, and enter the year the loss was incurred .... 52
Form 140X (2016)
Page 1 of 3
ADOR 10573 (16)

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