Form 140x - Individual Amended Return - 2000 (Page 2 of 2) in pdf

Form 140X (2000) Page 2

PART I Dependent Exemptions

Do not list yourself or spouse as dependents

List below the names of children and other dependents for which you are claiming an exemption. If more space is needed, attach a separate sheet.

No. of months

First name

Last name

Social security number

Relationship

lived in your home

For 1996 and 1997, enter the names of the dependents listed above who do not qualify as your dependent on your federal return because:

(1) The dependent's income was equal to or more than the federal exemption amount for the year.

(2) The dependent filed a joint federal return with his/her spouse

(3) You claimed the dependent under the Arizona age 65 or over rules

For 1998, 1999 and 2000 enter the names of any dependents age 65 or over listed above that you cannot claim as a dependent on your 1998, 1999 or 2000

federal return.

PART II Qualifying Parents and Ancestors of Your Parents Exemptions (1999 or 2000)

Arizona Residents Only

List below the names of 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 you filed.

No. of months

First name

Last name

Social security number

Relationship

lived in your home

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 agent's report. If you filed an amended federal return with the IRS (Form 1040X), please attach a

copy, plus all supporting schedules.

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

Please

Sign

Spouse's occupation

Spouse's signature

Date

Here

Firm's name (preparer's if self-employed)

Preparer's signature

Paid

Preparer's

Preparer's TIN

Preparer's address

Information

Date

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 06-0018 (00)

Form 140x - Individual Amended Return - 2000 Page 2

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