Arizona Form 309 - Credit For Taxes Paid To Another State Or Country - 2012 Page 2
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1
2
3
4Your Name (as shown on page 1)
Your Social Security Number
Schedule of Income Allocation
Complete this schedule only if you are an Arizona resident who is also considered to be a resident of another state under the laws of
that other state (dual resident); otherwise skip this schedule. See pages 2 and 8 of the instructions.
(a)
(b)
(c)
(d)
Amount entered
Amount entered in
in column (a)
column (c) that
Amount entered
reported on your
would be sourced to
Amount
in column (a)
2012 return filed
your statutory state of
reported on your
reported on your
to your statutory
residence as income of a
2012 federal return.
2012 Form 140.
state of residence.
nonresident of that state.
$
00 $
00 $
00 $
00
1
Wages, salaries, tips, etc. ...................
$
00 $
00 $
00 $
00
2
Interest................................................
$
00 $
00 $
00 $
00
3
Dividends ............................................
4
Business income or (loss) from
$
00 $
00 $
00 $
00
federal Schedule C .............................
5
Gains or (losses) from
$
00 $
00 $
00 $
00
federal Schedule D .............................
6
Rents, royalties, partnerships, estates,
trusts, small business corporations
$
00 $
00 $
00 $
00
from federal Schedule E .....................
7
Other income reported on
$
00 $
00 $
00 $
00
your federal return ..............................
$
00 $
00 $
00 $
00
8
Total Income: Add lines 1 through 7 ..
Other federal adjustments: List on
lines 9a through 9c:
$
00 $
00 $
00 $
00
9a
$
00 $
00 $
00 $
00
9b
$
00 $
00 $
00 $
00
9c
9d Total adjustments: Add lines 9a
$
00 $
00 $
00 $
00
through 9c for each column ................
10
Adjusted Gross Income: Subtract line
$
00 $
00 $
00 $
00
9d from line 8 for each column ...........
Print Schedule
ADOR 10136 (12)
AZ Form 309 (2012)
Page 2 of 2
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