Arizona Form 347 - Credit For Qualified Health Insurance Plans - 2012 Page 2
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1
2
3Your Name (as shown on page 1)
Your Social Security or Employer Identification Number
Part V
Available Credit Carryover
Since 2012 is the first year this credit is available, there is no carryover amount to claim for
taxable year 2012.
(a)
(b)
(c)
(d)
Carryover From
Available Carryover:
Taxable Year
Enter the
Amount
Subtract column (c)
Ending
Original Credit Amount
Previously Used
from column (b).
14
15
16
17
0
.00
TOTAL AVAILABLE CARRYOVER .....................................................
Part VI
Total Available Credit
18
Current year’s credit: Individuals, corporations, or S corporations that are claiming the credit,
00
enter the amount from Part II, line 6 ...............................................................................................
18
• S corporation shareholders: Enter the amount from Part III, line 10.
• Partners of a partnership: Enter the amount from Part IV, line 13.
0 00
19
Available carryover from Part V, line 17, column (d) ......................................................................
19
00
20
Total Available Credit: Add lines 18 and 19 ...................................................................................
20
• Corporations, including S corporations that are claiming the credit, enter the total here and
on Form 300, Part I, line 22.
• Individuals, enter the total here and on Form 301, Part I, line 28.
Print 347
ADOR 11177 (12)
AZ Form 347 (2012)
Page 2 of 2
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