ARIZONA FORM
343
2012
Renewable Energy Production Tax Credit
M M D D Y Y Y Y
M M D D Y Y Y Y
For the calendar year 2012, or fiscal year beginning
and ending
.
Attach to your return.
Name(s) as shown on Form 140, 140PY, 140NR, 140X, 120, 120A, 120S, 120X, or 165
Social security or employer identification number
Part I
Qualification for and Current Taxable Year’s Credit
1 Did you receive a Certificate from the Arizona Department of Revenue? .........................................
Yes
No
If “Yes”, attach a copy. If “No”, skip line 2.
00
2 Enter the credit amount on the Certificate from the Arizona Department of Revenue for this taxable year ......................
2
3 Did an entity from which you are claiming a pass through renewable energy production tax credit receive a Certificate
from the Arizona Department of Revenue? If “Yes”, attach a copy. If “No”, skip line 4 and line 5 ......
Yes
No
4 Enter the name of the entity that received the Certificate from the Arizona Department of Revenue
and its identification number. Be sure to attach a copy of the Certificate.
Name:
TIN:
5 Enter your share of the credit amount on the Certificate from the Arizona Department of Revenue for
00
this taxable year. See instructions ....................................................................................................................................
5
6 Total Credit. Add line 2 and line 5. Enter the total. This is your current year’s renewable energy production
00
tax credit ...........................................................................................................................................................................
6
Part II
S Corporation Credit Election and Shareholder’s Share of Credit
M M D D Y Y Y Y
7 The S Corporation has made an irrevocable election for the taxable year ending
to
(check only one box):
Claim the renewable energy production tax credit as shown on Part I, line 6 (for the taxable year mentioned above);
OR
Pass the renewable energy production tax credit as shown on Part I, line 6 (for the taxable year mentioned above) through to its shareholders.
Signature
Title
Date
• If passing the credit through to the shareholders, complete lines 8 through 10 separately for each shareholder.
• Also complete line 11 or line 12, as applicable, separately for each shareholder. Provide a copy of the Certificate to each shareholder.
• Furnish each shareholder with a copy pages 1 and 2 of Form 343.
8 Name of shareholder:
9 Shareholder’s TIN:
00
10 Shareholder’s share of the renewable energy production tax credit on Part I, line 6 ........................................................
10
00
11 Shareholder’s share of the amount on Part I, line 2 ..........................................................................................................
11
00
12 Shareholder’s share of the amount on Part I, line 5 ..........................................................................................................
12
Part III
Partner’s Share of Credit
• Complete lines 13 through 15 separately for each partner.
• Also complete line 16 or line 17, as applicable, separately for each partner. Provide a copy of the Certificate to each partner.
• Furnish each partner with a copy pages 1 and 2 of Form 343.
13 Name of partner:
14 Partner’s TIN:
00
15 Partner’s share of the renewable energy production tax credit on Part I, line 6 ................................................................
15
00
16 Partner’s share of the amount on Part I, line 2 ..................................................................................................................
16
00
17 Partner’s share of the amount on Part I, line 5 ..................................................................................................................
17
Continued on page 2
ADOR 11146 (12)