Arizona Form 140py - Part-Year Resident Personal Income Tax Return - 2011 Page 2
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1
2
3ARIZONA FORM
Part-Year Resident Personal Income Tax Return
FOR
140PY
CALENDAR YEAR
M M D D Y Y Y Y
M M D D Y Y Y Y
2011
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
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
Current Home Address - number and street, rural route
Apt. No. Daytime Phone (with area code)
Home Phone (with area code)
2
94
City, Town or Post Office
State
Zip Code
3
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
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
7
Single
88
8
Age 65 or over (you and/or spouse)
Enter the
number
9
Blind (you and/or spouse)
claimed.
Dependents. From page 2, line A2 –
10
do not include self or spouse.
Do not put a
81
80
from page 2, line A5.
check mark.
11
Qualifying parents and grandparents
12-13 Residency Status
: 12
Part-Year Resident Other than Active Military
13
Part-Year Resident Active Military
(check one)
00
14 Federal adjusted gross income
...................................................................
14
(from your federal return)
00
(from page 2, line B19)
15 Arizona income
.................................................................................................................................... 15
00
(from page 2, line C24)
16 Additions to income
............................................................................................................................. 16
17 Subtractions from income (from page 2, line D36) ............................................................................................................... 17
00
00
Add lines 15 and 16 then subtract line 17
18 Arizona adjusted gross income:
............................................................................ 18
I
S
00
See instructions, pages 15 and 16
19 Deductions. Check box and enter amount.
....
ITEMIZED
STANDARD 19
19
19
00
See page 16 of the instructions
20 Personal exemptions.
.............................................................................................................. 20
00
Subtract lines 19 and 20 from line 18. If less than zero, enter zero
21 Arizona taxable income:
......................................................... 21
00
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
00
00
Add lines 22 and 23
24 Subtotal of tax:
........................................................................................................................................ 24
00
See instructions, page 17
25 - 26 Clean Elections Fund Tax Reduction:
.........................
1
YOURSELF
2
SPOUSE 26
25
25
27 Reduced tax: Subtract line 26 from line 24 .......................................................................................................................... 27
00
28 Family income tax credit from worksheet on page 18 of the instructions ............................................................................. 28
00
29 Credits from Arizona Form 301, Part II, line 65, or Forms 310, 321, 322 and 323 if Form 301 is not required .................... 29
00
3
3
3
3
30
Enter form number of each credit claimed
30 Credit type:
................
00
(from worksheet on page 20 of the instructions)
31 Clean Elections Fund Tax Credit
........................................................................ 31
00
Subtract lines 28, 29 and 31 from line 27. If the sum of lines 28, 29 and 31 is more than line 27, enter zero
32 Balance of income tax:
... 32
00
(from worksheet on page 20 of instructions)
33 Unpaid Arizona use tax
........................................................................................... 33
00
Add lines 32 and 33
34 Balance of tax:
...................................................................................................................................... 34
00
35 Arizona income tax withheld during 2011 ............................................................................................................................. 35
00
36 Arizona estimated tax payments for 2011 ............................................................................................................................. 36
00
37 2011 Arizona extension payment (Form 204) ....................................................................................................................... 37
00
From worksheet on page 21 of the instructions
38 Increased Excise Tax Credit:
.............................................................................. 38
39 Other refundable credits: Check the box(es) and enter the amount ..........................
00
1
Form 308-I
2
Form 342 39
39
39
00
Add lines 35 through 39
40 Total payments/refundable credits:
............................................................................................... 40
00
If line 34 is larger than line 40, subtract line 40 from line 34, and enter amount of tax due. Skip lines 42, 43 and 44
41 TAX DUE:
............. 41
00
If line 40 is larger than line 34, subtract line 34 from line 40, and enter amount of overpayment
42 OVERPAYMENT:
............................. 42
00
43 Amount of line 42 to be applied to 2012 estimated tax ......................................................................................................... 43
00
Subtract line 43 from line 42
44 Balance of overpayment:
............................................................................................................. 44
Aid to Education
45 - 55 Voluntary Gifts to ...........................
00
00
45
Arizona Wildlife .............
46
(entire refund only) .........
Domestic Violence
0 00
00
00
Citizens Clean Elections ..
Child Abuse Prevention ...
47
48
Shelter .........................
49
Neighbors Helping
00
00
00
50
51
52
I Didn’t Pay Enough Fund
National Guard Relief Fund
Neighbors .....................
00
00
00
Special Olympics ...........
Veterans’ Donations Fund
Political Gift ..................
53
54
55
56 Check only one if making a political gift: ...............
1
Democratic
2
Green
3
Libertarian
4
Republican
56
56
56
56
00
57 Estimated payment penalty and MSA withdrawal penalty .................................................................................................... 57
58 Check applicable boxes .....
1
2
3
4
Annualized/Other
Farmer or Fisherman
Form 221 attached
MSA Penalty
58
58
58
58
00
59 Total of lines 45 through 55 and 57 ....................................................................................................................................... 59
00
60 REFUND:
Subtract line 59 from line 44. If less than zero, enter amount owed on line 61
................................................................ 60
if your deposit will be ultimately placed in a foreign account; see instructions ..........
A
A
Direct Deposit of Refund: Check box
60
60
ROUTING NUMBER
ACCOUNT NUMBER
C
Checking or
98
S
Savings
00
Add lines 41 and 59.
Make check payable to Arizona Department of Revenue; include SSN on payment
61 AMOUNT OWED:
.......... 61
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