Arizona Form 333 - Credit For Employing National Guard Members - 2012
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1
2
3ARIZONA FORM
333
2012
Credit for Employing National Guard Members
For the calendar year 2012 or
fiscal year beginning
M M D D Y Y Y Y
and ending
M M D D Y Y Y Y
.
Attach to your return.
Your Name as shown on Form 140, 140PY, 140NR, 140X, 120, 120A, 120S, 120X or 165
Your Social Security or
Employer Identification Number
Spouse’s Name as shown on Form 140, 140PY, 140NR, 140X (if a joint return)
Spouse’s Social Security Number
Part I
Business Information
1
Business name:
2
Business location:
3
Employer Identification Number:
Part II
Credit Computation
4
Number of qualifying employees placed on active duty during the current taxable year ...............
4
1,000 00
5
Credit per employee .......................................................................................................................
5
00
6
Multiply the number on line 4 by the amount on line 5 ...................................................................
6
Part III
S Corporation Credit Election and Shareholder’s Share of Credit
7
The S corporation has made an irrevocable election for the taxable year ending
M M D D Y Y Y Y
to (check only one box):
Claim the credit for employing national guard members, as shown on Part II, line 6 for the
taxable year mentioned above;
OR
Pass the credit for employing national guard members, as shown on Part II, 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. Furnish each shareholder with a copy of pages 1 and 2 of Form 333.
8
Name of shareholder:
9
Shareholder’s TIN:
00
10
Shareholder’s share of the amount on Part II, line 6 ......................................................................
10
Part IV
Partner’s Share of Credit
If passing the credit through to the partners, complete lines 11 through 13 separately for each partner. Furnish each
partner with a copy of pages 1 and 2 of Form 333.
11
Name of partner:
12
Partner’s TIN:
00
13
Partner’s share of the amount on Part II, line 6 ..............................................................................
13
Continued on page 2
ADOR 10714 (12)
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