Arizona Form 341-I - Credit For Business Contributions By An S Corporation To School Tuition Organizations For Displaced Students Or Students With Disabilities - Individual - 2015

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Credit for Business Contributions by an S Corporation
Arizona Form
2015
to School Tuition Organizations for Displaced Students
341-I
or Students with Disabilities - Individual
Include with your return.
For the calendar year 2015 or fiscal year beginning
M M D D
2 0 1 5 and ending
M M D D Y Y Y Y
.
Your Name as shown on Form 140, 140NR, 140PY, or 140X
Your Social Security Number
Spouse’s Name as shown on Form 140, 140NR, 140PY, or 140X (if a joint return)
Spouse’s Social Security Number
Part 1
School Tuition Organization Information
Check if you are claiming a pro rata credit from more than one S corporation. Complete and include a separate Part 1 for each
additional S corporation.
I am claiming a credit for my pro rata share of contributions made by the S corporation named below to the following
school tuition organizations:
S corporation name:
EIN:
If you need more space to list all school tuition organizations for which contributions were made by the S corporations identified
above, complete an additional schedule and include it with the credit form.
(a)
(b)
School Tuition Organization Name
Credit Approval Number
1
2
3
4
5
6
7
8
9
10
11 Amount of individual shareholder’s pro rata share of qualified contributions made to school tuition
00
11
organizations from the S corporation listed above ...............................................................................
Continued on page 2 
ADOR 11240 (15)

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