Arizona Form 140a - Resident Personal Income Tax Return (Short Form) - 2011 Page 16
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33FOR
ARIZONA FORM
CALENDAR YEAR
2011
140A
Resident Personal Income Tax Return (Short Form)
STOP
If your Arizona taxable income is $50,000 or more, you must use Arizona Form 140.
Check box 82F if filing under extension
82F
Your First Name and Initial
Last Name
Your Social Security No.
You must
1
enter your
Spouse’s First Name and Initial (if box 4 or 6 checked)
Last Name
Spouse’s Social Security No.
SSN(s).
1
Apt. No. Daytime Phone (with area code)
Home Phone (with area code)
Current Home Address - number and street, rural route
2
94
City, Town or Post Office
State
Zip Code
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
3
4
Married filing joint return
NAME OF QUALIFYING CHILD OR DEPENDENT
Head of household .......................... ►
5
Married filing separate return. Enter spouse’s name and Social Security No. above.
6
88
7
Single
Enter the
8
Age 65 or over (you and/or spouse)
81
80
number
9
Blind (you and/or spouse)
claimed.
From page 2, line A2 - do not include self or spouse.
10
Dependents.
Do not put a
check mark.
From page 2, line A5.
11
Qualifying parents and grandparents.
00
(from your federal return)
12 Federal adjusted gross income
..........................................................................................................
12
00
Multiply the number in box 8 by $2,100
13 Exemption - Age 65 or over:
..........................................................................................
13
00
Multiply the number in box 9 by $1,500
14 Exemption - Blind:
..........................................................................................................
14
00
Multiply the number in box 10 by $2,300
15 Exemption - Dependents:
............................................................................................
15
00
Multiply the number in box 11 by $10,000
16 Exemption - Qualifying parents and grandparents:
....................................................
16
00
Add lines 13 through 16
17 Total subtractions.
...............................................................................................................................
17
00
Subtract line 17 from line 12
18 Arizona adjusted gross income:
...............................................................................................
18
19 Standard deduction: If you checked filing status box 4 or 5, enter $9,406. If you checked box 6 or 7, enter $4,703 ..........
00
19
00
See page 7 of the instructions
20 Personal exemptions.
.................................................................................................................
20
...........
00
Subtract lines 19 and 20 from line 18. If less than zero, enter zero. If $50,000 or more, use Form 140
21 Arizona taxable income.
21
00
22 Amount of tax from Optional Tax Tables ................................................................................................................................
22
00
See instructions page 7
23 - 24 Clean Elections Fund Tax Reduction:
.............................
1
YOURSELF
2
SPOUSE
24
23
23
00
Subtract line 24 from line 22
25 Reduced tax:
.................................................................................................................................
25
00
(from worksheet on page 8 of instructions)
26 Family income tax credit
............................................................................................
26
27 Subtract line 26 from line 25: If less than zero, enter zero....................................................................................................
00
27
00
(from worksheet on page 8 of the instructions)
28 Clean Elections Fund Tax Credit
...........................................................................
28
00
Subtract line 28 from line 27. If line 28 is more than line 27, enter zero
29 Balance of income tax:
.......................................................
29
00
(from worksheet on page 9 of instructions)
30 Unpaid Arizona use tax
..............................................................................................
30
00
Add lines 29 and 30
31 Balance of tax:
........................................................................................................................................
31
00
32 Arizona income tax withheld during 2011 ..............................................................................................................................
32
00
33 2011 Arizona extension payment (Form 204) ........................................................................................................................
33
00
(from worksheet on page 10 of the instructions)
34 Increased Excise Tax Credit
................................................................................
34
00
35 Property Tax Credit
(from Form 140PTC)
..................................................................................................................................
35
00
Add lines 32 through 35
36 Total payments/credits:
....................................................................................................................
36
00
If line 31 is larger than line 36, subtract line 36 from line 31, and enter amount of tax due. Skip line 38
37 TAX DUE.
...............................
37
00
If line 36 is larger than line 31, subtract line 31 from line 36, and enter the amount of overpayment
38 OVERPAYMENT:
.........................
38
Aid to Education
00
00
39 - 49 Voluntary Gifts to ..............................
39
Arizona Wildlife .............
40
(entire refund only) .........
Domestic Violence
0 00
00
00
Citizens Clean Elections ..
Child Abuse Prevention ...
41
42
43
Shelter .........................
Neighbors Helping
00
00
00
44
45
46
I Didn’t Pay Enough Fund
National Guard Relief Fund
Neighbors .....................
00
00
00
Special Olympics ...........
Veterans’ Donations Fund
Political Gift ..................
47
48
49
50 Check only one if making a political gift .................
1
Democratic
2
Green
3
Libertarian
4
Republican
50
50
50
50
00
Add lines 39 through 49
51 Total voluntary gifts:
............................................................................................................................
51
00
Subtract line 51 from line 38. If less than zero, enter amount owed on line 53
52 REFUND:
.................................................................
52
if your deposit will be ultimately placed in a foreign account; see instructions.
A
A
Direct Deposit of Refund: Check box
52
52
ROUTING NUMBER
ACCOUNT NUMBER
C
Checking or
98
S
Savings
00
Add lines 37 and 51. Make check payable to Arizona Department of Revenue; include SSN on payment
53 AMOUNT OWED:
........
53
PLEASE BE SURE TO SIGN THE RETURN ON THE REVERSE SIDE OF THIS PAGE.
ADOR 10414 (11) Eff. 8/2/2012
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial