Arizona Form 140py - Part-Year Resident Personal Income Tax Return - 2011 Page 2

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ARIZONA FORM

FOR

Part-Year Resident Personal Income Tax Return

CALENDAR YEAR

140PY

Calculate

OR FISCAL YEAR BEGINNING

AND ENDING

2011

Check box 82F if filing under extension

Reset

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).

Current Home Address - number and street, rural route

Apt. No. Daytime Phone (with area code)

Home Phone (with area code)

City, Town or Post Office

State

Zip Code

NOTE: Yellow fields are Read-Only.

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

Married filing joint return

You can not enter data in the yellow fields. They

NAME OF QUALIFYING CHILD OR DEPENDENT

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

calculate as you enter data in the white fields.

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

Single

If the field doesn't seem to calculate, continue

Age 65 or over (you and/or spouse)

filling in the white fields and the calculations will

Enter the

"catch up".

number

Blind (you and/or spouse)

claimed.

Dependents. From page 2, line A2 –

Dependents

do not include self or spouse.

Do not put a

Use GREEN buttons to move around the form.

Qualifying parents and grandparents

check mark.

from page 2, line A5.

Part-Year Resident Other than Active Military

Part-Year Resident Active Military

12-13 Residency Status

: 12

(check one)

This box may be blank or may contain a printed barcode of data from your return.

14 Federal AGI ........

Income

I M P O R T A N T - P l e a s e R e a d

15 Arizona income

........ 15

(from page 2, line B19)

16 Additions to income

. 16

Additions

(from page 2, line C24)

- This form is provided in a fill-in-format.

17 Subtractions

............ 17

Subtractions

(from page 2, line D36)

- When this form is printed using the PRINT button on the upper right

........ 18

Lines (15 + 16) − line 17

18 Arizona AGI:

corner of this return, a two dimensional (2D) barcode is generated that

ITEMIZED

STANDARD

includes the data entered in this form.

20 Personal exemptions ................................ 20

Select Personal Exemptions

21 AZ taxable income:

- Using a 2D barcode vastly speeds up processing your return.

Line 18 − lines (19 + 20)

22 Compute the tax:

....... 22

X&Y Tax Table

Use Tax Table X or Y

- Do NOT handwrite any data on the form other than your signature(s).

23 Tax from recapture of credits .................... 23

24 Subtotal of tax:

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

- Use the PRINT button on this form to print your return.

Add lines 22 and 23

YOURSELF

SPOUSE 26

25 - 26

- Use the BLACK ink setting of your printer to print this return. Do not use

27 Reduced tax:

... 27

Subtract line 26 from line 24

the color ink setting.

28 Family income tax credit

(instructions p. 18)

29 Credits from Arizona Form 301, Part II, line 65, or Forms 310, 321, 322 and 323 if Form 301 is not required .................... 29

30 Credit type:

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

Enter form number of each credit claimed

31 Clean Elections Fund Tax Credit:

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

From worksheet on page 20 of the instructions

32 Balance of income tax:

... 32

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

Use Tax Worksheet

33 Unpaid Arizona use tax

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

(from worksheet on page 20 of instructions)

...................................................................................................................................... 34

Add lines 32 and 33

34 Balance of tax:

35 Arizona income tax withheld during 2011 ............................................................................................................................. 35

No Withholding? Click this button

36 Arizona estimated tax payments for 2011 ............................................................................................................................. 36

37 2011 Arizona extension payment (Form 204) ....................................................................................................................... 37

38 Increased Excise Tax Credit:

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

From worksheet on page 21 of the instructions

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

Form 308-I

Form 342 39

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

Add lines 35 through 39

40 Total payments/refundable credits:

............. 41

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:

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

If line 40 is larger than line 34, subtract line 34 from line 40, and enter amount of overpayment

42 OVERPAYMENT:

43 Amount of line 42 to be applied to 2012 estimated tax ......................................................................................................... 43

44 Balance of overpayment:

............................................................................................................. 44

Subtract line 43 from line 42

Aid to Education

45 - 55 Voluntary Gifts to ...........................

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

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

Domestic Violence

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

56 Check only one if making a political gift: ...............

Democratic

Green

Libertarian

Republican

57 Estimated payment penalty and MSA withdrawal penalty .................................................................................................... 57

Annualized/Other

Farmer or Fisherman

Form 221 attached

MSA Penalty

58 Check applicable boxes .....

59 Total of lines 45 through 55 and 57 ....................................................................................................................................... 59

................................................................ 60

Subtract line 59 from line 44. If less than zero, enter amount owed on line 61

60 REFUND:

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

.......... 61

Add lines 41 and 59.

61 AMOUNT OWED: