Arizona Form 347 - Credit For Qualified Health Insurance Plans - 2015
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1
2Arizona Form
2015
Credit for Qualified Health Insurance Plans
347
Include with your return.
For the calendar year 2015 or fiscal year beginning
2 0 1 5 and ending
.
M M D D
M M D D Y Y Y Y
Your Name as shown on Form 140, 140PY, 140NR, 140X, 99T, 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 Numbe
Available Credit Carryover
(a)
(b)
(c)
(d)
Taxable Year from
Original Credit Amount
Amount Previously Used
Available Carryover:
which you are
carrying a credit
Subtract column (c)
from column (b).
2012
00
00
00
1
2013
00
00
00
2
2014
00
00
00
3
4 TOTAL AVAILABLE CARRYOVER: Add lines 1 through 3 in column (d). Enter
00
the total on line 4, column (d) ..................................................................................
Individuals: Enter this amount on Arizona Form 301, Part 1, line 30, columns (b) and (c).
Corporations, including S corporations that are claiming the credit and exempt organizations with UBTI:
Also, enter this amount on Arizona Form 300, Part 1, line 22, columns (b) and (c).
Print 347
Instructions
The credit for qualified health insurance plans was repealed
For information or help, call one of the numbers listed:
effective for taxable years beginning from and after December 31,
Phoenix
(602) 255-3381
2014. Taxpayers cannot claim any new credits.
From area codes 520 and 928, toll-free
(800) 352-4090
If the credit was claimed in taxable years beginning prior to
Tax forms, instructions, and other tax information
January 1, 2015, and the amount of credit was more than your
If you need tax forms, instructions, and other tax information,
tax liability or if you had no tax, the unused credit may be carried
go to the department’s website at
forward for the next three consecutive tax years.
Income Tax Procedures and Rulings
Line-by-Line Instructions
These instructions may refer to the department’s income tax
Enter your name and social security number (SSN) as shown on
procedures and rulings for more information. To view or print
Arizona Forms 140, 140PY, 140NR, or 140X.
these, go to our website and click on Legal Research then click
on Procedures or Rulings and select a tax type from the drop
All returns, statements, and other documents filed with the
down menu.
department require a taxpayer identification number (TIN). The
TIN for an individual is the taxpayer’s SSN or an Internal Revenue
Publications and Brochures
Service (IRS) individual taxpayer identification number (ITIN).
To view or print the department’s publications and brochures,
Taxpayers that fail to include their identification number may be
go to our website and click on Publications.
subject to a penalty.
General Instructions
Available Credit Carryover
Lines 1 through 4 -
Individuals: You must also complete Arizona Form 301,
Nonrefundable Individual Tax Credits and Recapture, and
Complete lines 1 through 4 to figure your total available credit
include Forms 301 and 347 with your tax return to claim this
carryover from taxable years 2012, 2013, and 2014.
credit.
If you claimed the credit on your 2012, 2013, and/or 2014 return,
Corporate taxpayers including exempt organizations
and the credit was more than your tax.
with unrelated business taxable income: You must also
complete Arizona Form 300, Nonrefundable Corporate Tax
• In column (b), enter the credit originally computed for the
Credits and Recapture, and include Forms 300 and 347 with
taxable year listed in column (a).
your tax return to claim this credit.
ADOR 11177 (15)
Continued on page 2
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