Arizona Form 221 - Underpayment Of Estimated Tax By Individuals - 2012

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ARIZONA FORM

2012

Underpayment of Estimated Tax by Individuals

221

Attach to your return.

Name (first, middle initial, last) If joint return, also give spouse’s name and middle initial.

Social Security Number

Part A Calculation of Underpayment

1 I am claiming an exception from the imposition of the estimated payment penalty because I qualified for federal relief

under IRC §6654. Check box and see instructions .................................................................................................................

2 Amount of tax for 2012 from Form 140, page 1, line 21, or form 140PY, page 1, line 24, or Form 140NR, page 1, line 24 ....

3 Tax credits claimed on your 2012 Arizona return .....................................................................................................................

4 Subtract line 3 from line 2 ........................................................................................................................................................

5 Arizona tax withheld during 2012. Do not include any estimated tax payments or extension payments on this line ..............

6 Subtract line 5 from line 4. If less than $1,000, stop here. You do not owe the penalty. Do not file Form 221 .....................

7 Multiply line 4 by 90% (.90) ......................................................................................................................................................

8 Enter the immediately preceding year’s tax liability after tax credits. See instructions ...........................................................

9 Required Annual Payment: Enter the lesser of line 7 or line 8 .............................................................................................

(a)

(b)

(c)

(d)

10 Payment date .................................................................................................................... 10 Apr-17-2012 Jun-15-2012 Sep-17-2012 Jan-15-2013

11 Divide the amount on line 9 by the number of payments required for the year (usually

four). Enter the result in appropriate columns. If you use any other installment

method, check this box

. If you annualize, complete the worksheet on page 2 of

this form and enter the amount from line 23 of that worksheet in each column of line 11. 11

12 Estimated tax paid and income tax withheld. See instructions ........................................ 12

13 Overpayment: See instructions ........................................................................................ 13

14 Add lines 12 and 13 .......................................................................................................... 14

15 Underpayment: Subtract line 14 from line 11; or

Overpayment: Subtract line 11 from line 14 ................................................................... 15

Part B Underpayment of Estimated Tax Penalty

16 Rate Period One: 3% (Apr-17-12 through Jun-30-12)

Computation starting date for this period .......................................................................... 16

Apr-17-12

Jun-15-12

17 Number of days after the date on line 16 through the date the amount on line 15

was paid or June 30, 2012 whichever is earlier ................................................................ 17 Days:

Days:

18 Number of days on line 17

× 3% × underpayment on line 15

366

19 Rate Period Two: 3% (Jul-1-12 through Sep-30-12)

Computation starting date for this period .......................................................................... 19

Jun-30-12

Sep-17-12

20 Number of days after the date on line 19 through the date the amount on line 15

was paid or September 30, 2012 whichever is earlier ...................................................... 20 Days:

Days:

21 Number of days on line 20

× 3% × underpayment on line 15

366

22 Rate Period Three: 3% (Oct-1-12 through Dec-31-12)

Computation starting date for this period .......................................................................... 22

Sep-30-12

23 Number of days after the date on line 22 through the date the amount on line 15

was paid or December 31, 2012 whichever is earlier ....................................................... 23 Days:

Days:

24 Number of days on line 23

× 3% × underpayment on line 15

366

25 Rate Period Four: 3% (Jan-1-13 through Apr-15-13)

Computation starting date for this period .......................................................................... 25

Dec-31-12

Jan-15-13

26 Number of days after the date on line 25 through the date the amount on line 15

was paid or April 15, 2013 whichever is earlier ................................................................. 26 Days:

Days:

Number of days on line 26

underpayment on line 15 plus any penalty from

× 3% ×

Rate Periods One, Two and Three if the

365

underpayment is unpaid as of January 1, 2013

28 Penalty:

Column (a) - Add lines 18, 21, 24, 27. Enter the total on line 28 of column a.

Column (b) - Add lines 18, 21, 24, 27. Enter the total on line 28 of column b.

Column (c) - Add lines 21, 24, 27. Enter the total on line 28 of column c.

Column (d) - Enter the amount from column d, line 27

29 Penalty Limitation: In columns a through d, list the smaller of line 15 x 10% or

the amount from line 28 .................................................................................................... 29

30 TOTAL PENALTY: Add the amounts in columns a, b, c, and d, line 29 (see instructions) .....................................................................

ADOR 10642 (12)