Arizona Form 140nr - Nonresident Personal Income Tax Return

ARIZONA FORM

FOR

Nonresident Personal Income Tax Return

CALENDAR YEAR

140NR

2011

M M D D Y Y Y Y

OR FISCAL YEAR BEGINNING

AND ENDING

Check box 82F if filing under extension

82F

Your First Name and Initial

Last Name

Your Social Security No.

You must

enter your

Spouse’s First Name and Initial (if box 4 or 6 checked)

Last Name

Spouse’s Social Security No.

SSN(s).

Apt. No. Daytime Phone (with area code)

Home Phone (with area code)

Current Home Address - number and street, rural route

City, Town or Post Office

State

Zip Code

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

Married filing joint return

NAME OF QUALIFYING CHILD OR DEPENDENT

Head of household .......................... ►

Married filing separate return. Enter spouse’s name and Social Security No. above.

Single

Enter the number claimed. Do not put a check mark.

Age 65 or over (you and/or spouse)

Blind (you and/or spouse)

Dependents. From page 2, line A2 – Do not include self or spouse.

11-13 Residency Status (check one): 11

Nonresident 12

Nonresident Active Military 13

Composite Return

14 Federal adjusted gross income

...................................................................

(from your federal return)

(from page 2, line B16)

15 Arizona income

.................................................................................................................................... 15

(from page 2, line C21)

16 Additions to income

............................................................................................................................. 16

17 Subtractions from income (from page 2, line D32) ............................................................................................................... 17

Add lines 15 and 16 then subtract line 17

18 Arizona adjusted gross income:

............................................................................ 18

See instructions, page 12

19 Deductions: Check box and enter amount.

................

ITEMIZED

STANDARD

See page 13 of the instructions

20 Personal exemptions.

.............................................................................................................. 20

21 Arizona taxable income:

Subtract lines 19 and 20 from line 18

.................................................................................................. 21

22 Compute the tax using Tax Table X or Y ............................................................................................................................... 22

23 Tax from recapture of credits from Arizona Form 301, Part II, line 34 .................................................................................. 23

Add lines 22 and 23

24 Subtotal of tax:

........................................................................................................................................ 24

See instructions, pages 13 and 14

25 - 26 Clean Elections Fund Tax Reduction:

.............

YOURSELF

SPOUSE

27 Reduced tax:

Subtract line 26 from line 24

............................................................................................................................... 27

28 Credits from Arizona Form 301, Part II, line 65, or Forms 321, 322 and 323 if Form 301 is not required ............................ 28

Enter form number of each credit claimed

29 Credit type:

................

(from worksheet on page 15 of the instructions)

30 Clean Elections Fund Tax Credit

........................................................................ 30

Subtract lines 28 and 30 from line 27. If the sum of lines 28 and 30 is more than line 27, enter zero

31 Balance of income tax:

.............. 31

32 Unpaid Arizona use tax

(from worksheet on page 16 of instructions)

........................................................................................... 32

Add lines 31 and 32

33 Balance of tax:

...................................................................................................................................... 33

34 Arizona income tax withheld during 2011 ............................................................................................................................. 34

35 Arizona estimated tax payments for 2011 ............................................................................................................................. 35

36 2011 Arizona extension payment (Form 204) ....................................................................................................................... 36

37 Other refundable credits: Check the box(es) and enter the amount ..........................

Form 308-I

Form 342

Add lines 34 through 37

38 Total payments/refundable credits:

............................................................................................... 38

If line 33 is larger than line 38, subtract line 38 from line 33, and enter amount of tax due. Skip lines 40, 41 and 42

39 TAX DUE:

............. 39

If line 38 is larger than line 33, subtract line 33 from line 38, and enter amount of overpayment

40 OVERPAYMENT:

............................. 40

41 Amount of line 40 to be applied to 2012 estimated tax ......................................................................................................... 41

Subtract line 41 from line 40

42 Balance of overpayment:

............................................................................................................. 42

Aid to Education

43 - 53 Voluntary Gifts to ...........................

Arizona Wildlife .............

(entire refund only) .........

Domestic Violence

0 00

Citizens Clean Elections ..

Child Abuse Prevention ...

Shelter .........................

Neighbors Helping

I Didn’t Pay Enough Fund

National Guard Relief Fund

Neighbors .....................

Special Olympics ...........

Veterans’ Donations Fund

Political Gift ..................

54 Check only one if making a political gift ................

Democratic

Green

Libertarian

Republican

55 Estimated payment penalty and MSA withdrawal penalty .................................................................................................... 55

56 Check applicable boxes .....

Annualized/Other

Farmer or Fisherman

Form 221 attached

MSA Penalty

57 Total of lines 43 through 53 and 55 ....................................................................................................................................... 57

Subtract line 57 from line 42. If less than zero, enter amount owed on line 59

58 REFUND:

................................................................ 58

if your deposit will be ultimately placed in a foreign account; see instructions. .........

Direct Deposit of Refund: Check box

ROUTING NUMBER

ACCOUNT NUMBER

Checking or

Savings

Add lines 39 and 57. Make check payable to Arizona Department of Revenue; include SSN on payment

59 AMOUNT OWED:

............ 59