Instructions For Arizona Form 140nr - Nonresident Personal Income Tax Return

Arizona Form 140NR

2. In 2014, you paid more than $800 for either

Box 7 - Single

Arizona home health care or other medical costs for

If you are filing as single, check box 7.

the person.



Use this filing status if you were single on December 31,

A stillborn child if the following apply.

2014. You are single if any of the following apply to you.

1. The stillbirth occurred in Arizona during 2014.



You have never been married.

2. You received a certificate of birth resulting in



You are legally separated under a decree of divorce or

stillbirth from the Arizona Department of Health

of separate maintenance.

Services.



You were widowed before January 1, 2014, and you did

3. The child would have otherwise been a member of

not remarry in 2014, and you do not qualify to file as a

your household.

qualifying widow or widower with dependent children

Completing the Dependent Section

on your federal return.

If you need additional lines to list all of your dependents,

NOTE: If you got divorced during the year, see our income

complete page 3, Dependent Information – Continuation

tax ruling, ITR 14-2; and Publication 200 for help

Sheet, and include this page with your return. Be sure to

completing your return.

check the box indicating you are completing page 3.

Exemptions

Do not include page 3 with your return if you do not use it.

Dependent information:

children and other

Write the number of exemptions you are claiming in boxes

8, 9, and 10. Do not put a check mark. You may lose the

dependents

exemption if you put a checkmark in these boxes. You may

Enter the following.

lose the dependent exemption if you do not complete the

a) The dependent's name. If you are claiming an

Dependent section on page 1.

exemption for a stillborn child and the child was not

Box 8 - Age 65 or Over

named, enter “stillborn child” in place of a name.

Enter "1" in box 8 if you or your spouse were 65 or older in

b) The dependent's SSN. If you are claiming an exemption

2014. Enter "2" in box 8 if both you and your spouse were

for a stillborn child enter the certificate number from the

65 or older in 2014.

certificate of birth resulting in stillbirth.

Box 9 - Blind

c) The dependent's relationship to you.

Enter "1" in box 9 if you or your spouse is totally or partially

d) The number of months the dependent lived in your

blind. Enter "2" in box 9 if both you and your spouse are

home during 2014. If you are claiming an exemption for

totally or partially blind.

a stillborn child, enter the date of birth resulting in the

If you or your spouse were partially blind as of December

stillbirth.

31, 2014, you must get a statement certified by your eye

e) Check this box if this person did not qualify as a

doctor or registered optometrist that:

dependent on your federal return.

1. You cannot see better than 20/200 in your better eye with

Check the box if you did not claim this person (student)

glasses or contact lenses or

as a dependent on your federal return in order to allow

2. Your field of vision is 20 degrees or less.

that student to claim a federal education credit on the

student’s federal return.

If your eye condition is not likely to improve beyond the

conditions listed above, you can get a statement certified by

You may lose the exemption if you do not furnish this

your eye doctor or registered optometrist to that effect

information.

instead. You must keep the statement for your records.

Enter the total number of dependents listed on line 10 (Box).

Box 10 - Dependents

Reporting Your Residency Status

You must complete the Dependent section on page 1 of your

return before you can total your dependent exemptions. You

Check the appropriate box (11 through 13). Check only one box.

may claim only the following as a dependent.

Box 11 - Nonresident



A person that qualifies as your dependent on your

Check box 11, if you were not an Arizona resident during

federal return.

2014, and were not on active military duty in Arizona.

NOTE: If you do not claim a dependent exemption for a

Box 12 - Nonresident Active Military

student on your federal return in order to allow the student

to claim a federal education credit on the student’s federal

Check box 12, if you were a nonresident on active duty

return, you may still claim the exemption on your Arizona

military assignment in Arizona during 2014.

return.

For more information, see Arizona Individual

Box 13 - Composite Return

Income Tax Ruling ITR 05-02 at

Check box 13, if this is a composite return to be filed by one



A person who is age 65 or over (related to you or not)

of the following.

that does not qualify as your dependent on your federal

A partnership filing on behalf of its nonresident partners.

return, but one of the following applies.

2. An S corporation filing on behalf of its nonresident

In 2014, you paid more than one-fourth of the cost of

shareholders.

keeping this person in an Arizona nursing care

institution, an Arizona residential care institution, or

For information on filing an Arizona nonresident composite

income tax return, see Income Tax Ruling ITR 13-2.

an Arizona assisted living facility. Your cost must be

more than $800.

Instructions For Arizona Form 140nr - Nonresident Personal Income Tax Return - 2014 Page 5

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