Arizona Form 140 - Resident Personal Income Tax Return

Form 140

4. The number of months the dependent lived in your home

during 2010. If you are claiming an exemption for a stillborn

…E-F

EACE OF

IND

ILE

child, enter the date of birth resulting in the stillbirth.

You may lose the exemption if you do not furnish this

information.

Ask your tax professional for E-File

Line A2 - Total Dependents

Do-it-yourself using the Internet

Enter the total number of persons listed on line(s) A1. Enter

the same number on the front of the return in box 10.

Lines A3a and A3b - Persons You Did Not

Take as Dependents on Your Federal

Return

Line 10 Box - Dependents

On line A3a, enter the following.

You must complete Part A, lines A1 through A3b, on page 2 of

your return before you can total your dependent exemptions.

1. The names of any dependents age 65 or over listed on

You may claim only the following as a dependent.

line(s) A1 that you cannot take as a dependent on your



federal return.

A person that qualifies as your dependent on your federal

return.

2. The name of any stillborn child listed on line(s) A1, if

the stillborn child was named. If the stillborn child was

NOTE: If you do not claim a dependent exemption for a

not named, enter “stillborn child” on line A3a. Also

student on your federal return in order to allow the student

enter the date of birth resulting in the stillbirth.

to claim a federal education credit on the student’s federal

On line A3b, enter the name of any student listed on line(s) A1

return, you may still claim the exemption on your Arizona

that you did not claim as an exemption on your federal return

return. For more information, see Arizona Individual

in order to allow that student to claim a federal education

Income Tax Ruling ITR 05-02.

credit on the student’s federal return.



A person who is age 65 or over (related to you or not)

Line 11 Box - Qualifying Parents and

that does not qualify as your dependent on your federal

Ancestors of Your Parents

return, but one of the following applies.

A qualifying parent or ancestor of your parent may be any

1. In 2010, you paid more than one-fourth of the cost

one of the following.

of keeping this person in an Arizona nursing care



institution, an Arizona residential care institution,

Your parent or your parent’s ancestor. Your parent’s

or an Arizona assisted living facility. Your cost

ancestor is your grand parent, great grand parent, great

must be more than $800.

great grand parent, etc.



2. In 2010, you paid more than $800 for either

If married filing a joint return, your spouse’s parent or

Arizona home health care or other medical costs for

an ancestor of your spouse’s parent.

the person.

You may claim this exemption if all of the following apply.



A stillborn child if the following apply:

1. The parent or ancestor of your parent lived in your

principal residence for the entire taxable year.

1. The stillbirth occurred during 2010.

2. You paid more than one-half of the support and

2. You received a certificate of birth resulting in stillbirth

from the Arizona Department of Health Services.

maintenance costs of the parent or ancestor of your

parent during the taxable year.

3. The child would have otherwise been a member of your

household.

3. The parent or ancestor of your parent was 65 years old

or older during 2010.

Completing Line(s) A1

4. The parent or ancestor of your parent required assistance

NOTE: If a person who qualifies as your dependent is also

with activities of daily living, like getting in and out of

a qualifying parent or ancestor of your parent, you may claim

bed or chairs, walking around, going outdoors, using the

that person as a dependent on line A2, or you may claim that

toilet, bathing, shaving, brushing teeth, combing hair,

person as a qualifying parent or ancestor of your parent on

dressing, medicating or feeding.

line A5. You may not claim that same person on both line A2

You must complete Part A, lines A4 and A5, on page 2 of

and line A5. Do not list the same person on line A1 that you

your return before you can total your exemptions for

listed on line A4.

qualifying parents and ancestors of your parents.

Enter the following on line(s) A1.

NOTE: If a person who is a qualifying parent or ancestor of

1. The dependent's name. If you are claiming an

your parent also qualifies as your dependent, you may claim

exemption for a stillborn child and the child was not

that person as a dependent on line A2, or you may claim that

named, enter “stillborn child” in place of a name.

person as a qualifying parent or ancestor of your parent on

2. The dependent's SSN. If you are claiming an exemption

line A5. You may not claim that same person on both line A2

for a stillborn child enter the certificate number from the

and line A5. Do not list the same person on line A4 that you

certificate of birth resulting in stillbirth.

listed on line A1.

3. The dependent's relationship to you.

Arizona Form 140 - Resident Personal Income Tax Return - 2010 Page 6

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