Arizona Form 120a - Arizona Corporation Income Tax Return (Short Form)

AZ Form 120A (2002) Page 2

Schedule A - Additions to Taxable Income

A1 Federal bonus depreciation allowed under IRC § 168(k) - see instructions .................................................................................

A2 Federal income tax refunds received in the taxable year - see instructions .................................................................................

A3 Taxes based on income paid to any state (INCLUDING ARIZONA), local governments or foreign governments .......................

A4 Interest on obligations of other states, foreign countries, or political subdivisions .......................................................................

A5 Special deductions claimed on federal return...............................................................................................................................

A6 Federal net operating loss deduction claimed on federal return...................................................................................................

A7 Commissions and other expenses paid or accrued to a Domestic International Sales Corporaton (DISC) .................................

A8 Capital investment by qualiﬁ ed defense contractor - attach schedule..........................................................................................

A9 Claim of right adjustments - attach schedule................................................................................................................................

A10 Additions related to Arizona tax credits - attach schedule ............................................................................................................

A10

A11 Other additions to federal taxable income - attach schedule........................................................................................................

A11

A12 Total - add lines A1 through A11. Enter total here and on page 1, line 2 ......................................................................................

A12

Schedule B - Subtractions From Taxable Income

B1 Arizona adjustment for IRC § 168(k) bonus depreciation - see instructions .................................................................................

B2 Arizona depreciation adjustment for property sold or otherwise disposed of during the taxable year - see instructions..............

B3 Dividends received from 50% or more controlled domestic corporations.....................................................................................

B4 Foreign dividend gross-up ............................................................................................................................................................

B5 Dividends received from foreign corporations ..............................................................................................................................

B6 Dividends received from a DISC...................................................................................................................................................

B7 Interest on U.S. obligations...........................................................................................................................................................

B8 Agricultural crops charitable contribution ......................................................................................................................................

B9 Capital investment by qualiﬁ ed defense contractor - attach schedule..........................................................................................

B10 Claim of right adjustments - attach schedule................................................................................................................................

B10

B11 Other subtractions from federal taxable income - attach schedule...............................................................................................

B11

B12 Total - add lines B1 through B11. Enter total here and on page 1, line 4......................................................................................

B12

Schedule C - Additional Information

C1 Date business began in Arizona ______/______/______

YYYY

C2 Address at which tax records are located for audit purposes: _____________________________________________________________________

C3 The taxpayer designates the individual listed below as the person to contact to schedule an audit of this return and authorizes

the disclosure of conﬁ dential information to this individual. (See instruction page 12)

Name and title ____________________________________________________________ Phone # _(_______)____________________________

C4 List prior taxable years for which a federal examination has been ﬁ nalized __________________________________________________________

_____________________________________________________________________________________________________________________

NOTE: ARS § 43-327 requires the taxpayer, within ninety days after ﬁ nal determination, to report these changes under separate

cover to the Arizona Department of Revenue or to ﬁ le amended returns reporting these changes. (See instruction page 3)

C5 Amount of Arizona taxable income for prior taxable year (2001 Form 120A, line 7) ____________________________________________________

C6 Indicate tax accounting method:

Cash

Accrual

Other

(Specify method) ________________________________________

___________________________________________________________________________________________________________________________________

Certiﬁ cation

The following certiﬁ cation must be signed by one or more of the following ofﬁ cers (president, treasurer, or any other principal ofﬁ cer).

Under penalties of perjury, I (we), the undersigned ofﬁ cer(s) authorized to sign this return, declare that I (we) have examined this return, including the

accompanying schedules and statements, and to the best of my (our) knowledge and belief, it is a true, correct and complete return, made in good faith, for

the taxable year stated pursuant to the income tax laws of the State of Arizona.

Please

___________________________________________________________________________________________________________________________________

Ofﬁ cer’s signature

Title

Date

Sign

Here

___________________________________________________________________________________________________________________________________

Ofﬁ cer’s signature

Title

Date

____________________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________

Paid

Preparer’s signature

Date

Preparer’s

___________________________________________________________________________________________________________________________________

Use Only

Firm’s name (or preparer’s, if self-employed)

Preparer’s TIN

___________________________________________________________________________________________________________________________________

Firm’s address

Zip code

ADOR 91-0023 (02)

Arizona Form 120a - Arizona Corporation Income Tax Return (Short Form) - 2002 Page 2

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