ARIZONA FORM
141AZ
Nonresident Beneficiary’s
2011
Share of Income and
Schedule K-1(NR)
Share of Fiduciary Adjustment
For calendar year 2011, or
fiscal year beginning
M M D D Y Y Y Y
and ending
M M D D Y Y Y Y
.
Name of Estate or Trust
Estate or Trust Employer Identification No. (EIN)
Beneficiary’s Name
Beneficiary’s I.D. No.
Fiduciary’s Name
Beneficiary’s Address - number and street, or rural route
Fiduciary’s Address - number and street, or rural route
Beneficiary’s City, Town or Post Office State
Zip Code
Fiduciary’s City, Town or Post Office
State
Zip Code
Beneficiary’s Daytime Phone Number – include area code
Fiduciary’s Phone Number – include area code
Part I Arizona Nonresident Beneficiary’s Share of
Federal Distributable Income from Arizona Sources
1 Federal distributable net income from Arizona sources: Enter the amount
00
from Form 141AZ, Schedule D, line D9, column (c)............................................
1
2 Beneficiary’s share of the amount entered on line 1: Nonresident individual
beneficiaries, also enter this amount on Form 140NR, page 2, line B11,
00
Arizona column....................................................................................................
2
Part II Arizona Nonresident Beneficiary’s Share of
Fiduciary Adjustment Related to Arizona Source Income
3 Net fiduciary adjustment to be allocated: Enter the amount from
Form 141AZ, Schedule C, line C14.....................................................................
3
00
4 Amount on line 3 related to Arizona source income allocated to nonresident
beneficiaries ........................................................................................................
4
00
5 Beneficiary’s share of the amount entered on line 4 ...........................................
5
00
• If the amount on line 5 is a positive number, enter this amount as an other
addition to income on Arizona Form 140NR, page 2, line C20.
• If the amount on line 5 is a negative number, enter this amount as an other
subtraction from income on Arizona Form 140NR, page 2, line D31.
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ADOR 10586 (11)