Arizona Form 140a - Resident Personal Income Tax Return (Short Form)

ARIZONA FORM

Resident Personal Income Tax Return (Short Form)

2002

140A

Your ﬁ rst name and initial

Last name

Your Social Security Number

If a joint return, spouse’s ﬁ rst name and initial

Last name

Spouse’s Social Security Number

Present home address - number and street, rural route, apt. no.

Daytime phone: (

)

IMPORTANT

Home phone: (

)

You must enter your SSNs.

City, town or post ofﬁ ce

State

Zip Code

FOR DOR USE ONLY

Married ﬁ ling joint return

Head of household - name of qualifying child or dependent:

Married ﬁ ling separate return. Enter spouse’s Social Security Number above

and full name here.

►

Single

Age 65 or over (you and/or spouse)

Enter the

number

Blind (you and/or spouse)

CHECK ONE if ﬁ ling under an extension:

claimed. Do

Dependents. From page 2, line A2 - do not include self or spouse.

4 month extension

not put a

82D

check mark.

6 month extension

Qualifying parents and ancestors of your parents. From page 2, line A5.

82F

12 Federal adjusted gross income (from your federal return)................................................................................................................... 12

13 Exemption - Age 65 or over: Multiply the number in box 8 by $2,100 ....................................................... 13

14 Exemption - Blind: Multiply the number in box 9 by $1,500....................................................................... 14

15 Exemption - Dependents: Multiply the number in box 10 by $2,300 ......................................................... 15

16 Exemption - Qualifying parents and ancestors of your parents: Multiply the number in box 11 by $10,000. 16

17 Total subtractions. Add lines 13 through 16. ....................................................................................................................................... 17

18 Arizona adjusted gross income. Subtract line 17 from line 12. ........................................................................................................... 18

19 Standard deduction. If you checked ﬁ ling status box 4 or 5, enter $8,100. If you checked box 6 or 7, enter $4,050........................ 19

20 Personal exemptions. See page 5 of the instructions......................................................................................................................... 20

21 Arizona taxable income. Subtract lines 19 and 20 from line 18. If less than zero, enter zero............................................................ 21

22 Amount of tax from Optional Tax Rate Tables...................................................................................................................................... 22

23 - 24 Clean Elections Fund Tax Reduction. See instructions page 6.

YOURSELF

SPOUSE.............................. 24

25 Reduced tax. Subtract line 24 from line 22......................................................................................................................................... 25

26 Family income tax credit from worksheet on page 7 of instructions .................................................................................................... 26

27 Subtract line 26 from line 25. If less than zero, enter zero ................................................................................................................. 27

28 Clean Elections Fund Tax Credit. From worksheet on page 7............................................................................................................ 28

29 Balance of tax. Subtract line 28 from line 27. If line 28 is more than line 27, enter zero ................................................................... 29

30 Arizona income tax withheld during 2002 ................................................................................................... 30

31 Amount paid with 2002 Arizona extension request (Form 204) .................................................................. 31

32 Increased Excise Tax Credit from worksheet on page 8............................................................................. 32

33 Property Tax Credit from Form 140PTC ..................................................................................................... 33

34 Total payments/credits. Add lines 30 through 33 ................................................................................................................................ 34

35 TAX DUE. If line 29 is larger than line 34, subtract line 34 from line 29, and enter amount of tax due. Skip line 36 ........................ 35

36 OVERPAYMENT. If line 34 is larger than line 29, enter amount of overpayment. ............................................................................. 36

37 - 44 Voluntary Gifts to:

Aid to Education

Arizona Wildlife 38

Citizens Clean Elections 39

(enter entire refund only)

Domestic Violence Shelter 41

Child Abuse Prevention 40

Neighbors Helping 42

Neighbors

Political Gift 44

Special Olympics 43

45 Check only one if making a political gift:

Democratic

Libertarian

Republican

46 Total voluntary gifts: Add lines 37 through 44 ..................................................................................................................................... 46

47 REFUND. Subtract line 46 from line 36. If less than zero, enter amount owed on line 48. ............................................................... 47

Direct Deposit of Refund: See instructions.

ROUTING NUMBER

ACCOUNT NUMBER

Checking or

Savings

48 AMOUNT OWED. Add lines 35 and 46. Make check payable to Arizona Department of Revenue; include SSN on payment. 48

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

ADOR 91-0012 (02)