Name of Spouse – claiming more than 1/2 of the total exemption as shown on page 1
Social Security No.
Name of Spouse – claiming less than 1/2 of the total exemption as shown on page 1
Social Security No.
Part III: For Full-Year Residents Only (Form 140 or 140A)
Claiming at Least One Dependent
SPOUSE CLAIMING
SPOUSE CLAIMING
MORE THAN 1/2
LESS THAN 1/2
$
6,300.00 $
6,300.00
1 Total personal exemption allowed married taxpayers claiming at least one dependent ................. 1
2 Amount of personal exemption each spouse is claiming on his or her separate Arizona return.
Enter the result here. Also enter the result on Form 140, page 1, line 19, or Form 140A, page 1,
line 20. If one spouse is a nonresident or part-year resident, that spouse should
$
.00 $
.00
complete Part IV below ................................................................................................................... 2
Part IV: For Part-Year Residents (Form 140PY) or
Nonresidents (Form 140NR) Claiming at Least One Dependent
SPOUSE CLAIMING
SPOUSE CLAIMING
MORE THAN 1/2
LESS THAN 1/2
1 Total personal exemption allowed (prior to prorating) married taxpayers claiming at least
$
6,300.00 $
6,300.00
one dependent ................................................................................................................................ 1
2 Amount of personal exemption each spouse is claiming (prior to prorating) on his or her
separate Arizona return. If you are a part-year resident who is an active duty military member
who either began or gave up Arizona residency during 2013, skip lines 3 and 4, and
enter this amount on Form 140PY, page 1, line 22. If you are a nonresident who is an active
military member, skip lines 3 and 4, and enter this amount on Form 140NR, page 1, line 22.
$
.00 $
.00
All other taxpayers complete lines 3 and 4 ..................................................................................... 2
3 If you are a part-year resident, enter your Arizona percentage from Form 140PY, page 2,
line B20. If you are a nonresident, enter your Arizona percentage from Form 140NR,
%
%
page 2, line B17 .............................................................................................................................. 3
4 Multiply line 2 by the percentage on line 3. If you are a part-year resident, enter the result here
and on Form 140PY, page 1, line 22. If you are a nonresident, enter the result here and on
$
.00 $
.00
Form 140NR, page 1, line 22 . ......................................................................................................... 4
We, the undersigned, agree to divide the personal exemption as shown in Part I, Part II, Part III or Part IV of this
form. Both spouses must sign:
Signature of spouse claiming more than one-half (1/2) of total personal exemption
Date
Signature of spouse claiming less than one-half (1/2) of total personal exemption
Date
Print Form
AZ Form 202 (2013)
ADOR 10167 (13)
Page 2 of 2