Arizona Form 140ez - Resident Personal Income Tax Return (Ez Form) - 2011 Page 2

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FOR

ARIZONA FORM

CALENDAR YEAR

140EZ

2011

Resident Personal Income Tax Return (EZ Form)

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 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

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

Reset Form

Print 140EZ return

You must use Arizona Form 140 if:

STOP

• Your Arizona taxable income on line 8 is $50,000 or more

YELLOW fields are Read-Only. You can

• You are claiming estimated payments

not enter data in yellow fields.

FILING STATUS: Check one box.

Note: Selecting the Filing Status on Line 4 or 5

These fields are calculated as you fill in

Married filing joint return

will fill in the Standard Deduction and Personal

the form.

Single

Exemption value on Line 7.

6 Federal adjusted gross income from your federal return .............................................................................

7 Standard deduction and personal exemption: If you checked filing status box 4, enter $13,606; if you

checked filing status box 5, enter $6,803 .....................................................................................................

8 Arizona taxable income: Subtract line 7 from line 6. If less than zero, enter zero .....................................

Go to Optional Tax Table

9 Amount of tax from Optional Tax Tables ......................................................................................................

10 - 11 Clean Elections Fund Tax Reduction: See instructions page 5

YOURSELF

SPOUSE 11

....

12 Reduced tax: Subtract line 11 from line 9 ................................................................................................... 12

13 Family income tax credit from worksheet on page 5 of instructions............................................................. 13

14 Clean Elections Fund Tax Credit from worksheet on page 5 of the instructions .......................................... 14

15 Balance of income tax: Subtract lines 13 and 14 from line 12. If the sum of lines 13 and 14 is more than

line 12, enter zero ........................................................................................................................................ 15

Use Tax Worksheet

16 Unpaid Arizona use tax (from worksheet on page 6 of instructions) ............................................................ 16

17 Balance of tax: Add lines 15 and 16 .......................................................................................................... 17

18 Arizona income tax withheld during 2011 ..................................................................................................... 18

19 2011 Arizona extension payment (Form 204) .............................................................................................. 19

20 Increased Excise Tax Credit from worksheet on page 7 of the instructions ................................................. 20

21 Total payments/credits: Add lines 18 through 20 ..................................................................................... 21

22 TAX DUE: If line 17 is more than line 21, subtract line 21 from line 17. Skip lines 23 and 25 ................... 22

23 OVERPAYMENT: If line 21 is more than line 17, subtract line 17 from line 21 ........................................... 23

24 VOLUNTARY CONTRIBUTION to the Citizens Clean Elections Fund:

See page 7 of instructions. If making a contribution, check this box:

and

enter the amount ........................................................................................................ 24

25 REFUND: Subtract line 24 from line 23. If less than zero, enter amount owed on line 26 ........................ 25

Direct Deposit of Refund: Check box

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

ROUTING NUMBER

ACCOUNT NUMBER

Checking or

Savings

26 AMOUNT OWED: Add lines 22 and 24. Make check payable to Arizona Department of Revenue;

include SSN on payment ........................................................................................................................... 26

27 Last name(s) used in prior years - if different from name(s) used in current year

I have read this return and any attachments with it. Under penalties of perjury, I declare that to the best of my knowledge and belief, they are

true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

YOUR SIGNATURE

DATE

OCCUPATION

SPOUSE’S SIGNATURE

DATE

SPOUSE’S OCCUPATION

PAID PREPARER’S SIGNATURE

DATE

FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED)

PAID PREPARER’S TIN

PAID PREPARER’S ADDRESS

PAID PREPARER’S PHONE NO.

If you are sending a payment with this return, mail to Arizona Department of Revenue, PO Box 52016, Phoenix, AZ, 85072-2016.

If you are expecting a refund or owe no tax, or owe tax but are not sending a payment, mail to Arizona Department of Revenue, PO Box 52138, Phoenix, AZ, 85072-2138.

ADOR 10534 (11)

1250 v1

MAILING TIP: Mailing your return to the correct P. O. Box speeds up the handling of your return!