Arizona Form 140a - Resident Personal Income Tax Return (Short Form) - 2011 Page 2
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10FOR
ARIZONA FORM
CALENDAR YEAR
2011
140A
Resident Personal Income Tax Return (Short Form)
STOP
If your Arizona taxable income is $50,000 or more, you must use Arizona Form 140.
Print 140A Return
Reset
Calculate
Check box 82F if filing under extension
x
89
82F
Your First Name and Initial
Last Name
Your Social Security No.
You must
1
enter your
Spouse’s First Name and Initial (if box 4 or 6 checked)
Last Name
Spouse’s Social Security No.
SSN(s).
1
Current Home Address - number and street, rural route
Apt. No. Daytime Phone (with area code)
Home Phone (with area code)
2
94
City, Town or Post Office
State
Zip Code
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
NOTE - Yellow fields are Read-Only.
3
You can not enter data in the yellow fields.
4
Married filing joint return
They calculate as you enter data in the
NAME OF QUALIFYING CHILD OR DEPENDENT
Head of household .......................... ►
5
white fields.
6
Married filing separate return. Enter spouse’s name and Social Security No. above.
88
If a field doesn't seem to calculate, continue
7
Single
filling in the white fields and the calculations
will "catch up".
Enter the
8
Age 65 or over (you and/or spouse)
81
80
number
9
Blind (you and/or spouse)
Go to DEPENDENTS: Page 2, Part A
claimed.
10
Dependents.
From page 2, line A2 - do not include self or spouse.
Do not put a
Use GREEN buttons to move around the return.
check mark.
11
Qualifying parents and grandparents.
From page 2, line A5.
This box may be blank or may contain a printed barcode of data from your return.
00
12 Federal adjusted gross income ..................
12
I M P O R T A N T - Please Read
00
Line 13 = Box 8 x $2,100
13 Age 65 or over ............................................
13
- This form is provided in a fill-in format.
Line 14 = Box 9 x $1,500
00
14 Blind ............................................................
14
Line 15 = Box 10 x $2,300
00
15 Dependents ................................................
15
- When this form is printed using the PRINT button on the upper right
Line 16 = Box 11 x $10,000
00
16 Qualifying parents and grandparents .........
16
corner of this return, a two dimensional (2D) barcode is generated that
includes the data entered in the form.
00
17 Total subtractions.
...
17
Add lines 13 through 16
0
00
18 Arizona AGI:
.....
18
Subtract line 17 from line 12
- Using a 2D barcode vastly speeds up processing your return.
00
19 Standard deduction ....................................
Select Standard Deduction
19
- Do NOT handwrite any data on the form other than your signature(s).
00
20 Personal exemptions ..................................
Select Personal Exemption Filing Status
20
0
00
Line 18 − lines (19 + 20)
21 AZ taxable income:
.
21
- Use the PRINT button on this form to print this return.
Tax Table
00
22 Tax from Optional Tax Tables ......................
22
00
- Use the BLACK ink setting of your printer to print this return. Do not use
23 - 24
1
YOURSELF
2
SPOUSE
24
23
23
the color ink setting.
00
25 Reduced tax:
.....
25
Subtract line 24 from line 22
00
26 Family income tax credit
............................................................................................
26
(from worksheet on page 8 of instructions)
00
27 Subtract line 26 from line 25: If less than zero, enter zero....................................................................................................
27
00
28 Clean Elections Fund Tax Credit
...........................................................................
28
(from worksheet on page 8 of the instructions)
0
00
29 Balance of income tax:
.......................................................
29
Subtract line 28 from line 27. If line 28 is more than line 27, enter zero
Use Tax Worksheet
00
30 Unpaid Arizona use tax
..............................................................................................
30
(from worksheet on page 9 of instructions)
0
00
31 Balance of tax:
........................................................................................................................................
31
Add lines 29 and 30
00
32 Arizona income tax withheld during 2011 ..............................................................................................................................
32
00
33 2011 Arizona extension payment (Form 204) ........................................................................................................................
33
00
34 Increased Excise Tax Credit
................................................................................
34
(from worksheet on page 10 of the instructions)
00
35 Property Tax Credit
..................................................................................................................................
35
(from Form 140PTC)
00
36 Total payments/credits:
....................................................................................................................
36
Add lines 32 through 35
00
37 TAX DUE.
...............................
37
If line 31 is larger than line 36, subtract line 36 from line 31, and enter amount of tax due. Skip line 38
00
38 OVERPAYMENT:
.........................
38
If line 36 is larger than line 31, subtract line 31 from line 36, and enter the amount of overpayment
Aid to Education
00
00
39 - 49 Voluntary Gifts to ..............................
39
Arizona Wildlife .............
40
(entire refund only) .........
Domestic Violence
0
00
00
00
Citizens Clean Elections ..
Child Abuse Prevention ...
41
42
Shelter .........................
43
Neighbors Helping
00
00
00
44
45
46
I Didn’t Pay Enough Fund
National Guard Relief Fund
Neighbors .....................
00
00
00
Special Olympics ...........
Veterans’ Donations Fund
Political Gift ..................
47
48
49
50 Check only one if making a political gift .................
1
Democratic
2
Green
3
Libertarian
4
Republican
50
50
50
50
00
51 Total voluntary gifts:
............................................................................................................................
51
Add lines 39 through 49
00
52 REFUND:
.................................................................
52
Subtract line 51 from line 38. If less than zero, enter amount owed on line 53
A
A
Direct Deposit of Refund: Check box
if your deposit will be ultimately placed in a foreign account; see instructions.
52
52
ROUTING NUMBER
ACCOUNT NUMBER
C
Checking or
98
S
Savings
00
53 AMOUNT OWED:
........
53
Add lines 37 and 51. Make check payable to Arizona Department of Revenue; include SSN on payment
PLEASE BE SURE TO SIGN THE RETURN ON THE REVERSE SIDE OF THIS PAGE.
ADOR 10414 (11)
1250 v2
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