Arizona Form 140x - Individual Amended Income Tax Return - 2015
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1
2
3Arizona Form
FOR CALENDAR YEAR
Individual Amended Income Tax Return
2015
140X
M M D D
2 0 1 5
M M D D Y Y Y Y
. 66
OR FISCAL YEAR BEGINNING
AND ENDING
Your First Name and Middle Initial
Last Name
Your Social Security Number
Enter
1
your
Spouse’s First Name and Middle Initial (if box 4 or 6 checked)
Last Name
Spouse’s Social Security No.
SSN(s).
1
Current Home Address - number and street, rural route
Apt. No.
Daytime Phone (with area code)
94
2
City, Town or Post Office
State
ZIP Code
Last Names Used in Last Four Prior Year(s) (if different)
97
3
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
Check a box to indicate both filing and residency status:
88
4
Married filing joint return
5
Head of household:
Enter name of qualifying child or dependent on next line:
6
Married filing separate return:
Enter spouse’s name and Social Security Number above.
7
Single
Enter the number claimed. Do not check
8
Resident
9a
Nonresident
9b
Composite
13 Age 65 or over ..................................
81 PM
80 RCVD
10
Nonresident active military
14 Blind ..................................................
11
Part-year resident
15 Dependents ......................................
12
Part-year resident active military
16 Qualifying parents or grandparents ..
00
17 Federal adjusted gross income (from your federal return) ...................................................................................... 17
00
18 Nonresidents and part-year residents only: Enter Arizona gross income here.............................................................. 18
18a Arizona income ratio: If you checked box 9a, 10, 11 or 12, divide line 18 by line 17 and enter the result (not over 1.000) 18a
00
19 Additions to income.
............................................................................................................................... 19
See instructions
00
20 Subtotal: Residents:
Nonresidents and part-year residents:
...................... 20
Add line 17 and line 19.
Add lines 18 and 19
00
21 Subtractions from income.
...................................................................................................................... 21
See instructions
00
22 Net capital gain derived from Investment in Qualified Small Business........................................................................... 22
00
23 Net capital gain or (loss):
......................................................................
A
See instructions
23
00
24 Net long-term capital gain subtraction from assets acquired after December 31, 2011 ................................................. 24
00
25 Contributions to 529 College Savings Plans .................................................................................................................. 25
00
26 Arizona adjusted gross income:
............................. 26
Subtract lines 21, 22, 24, and 25 from line 20, and enter the difference
00
27 Deductions: Check box and enter amount.
I
ITEMIZED
S
STANDARD 27
........................
See instructions
27
27
00
28 Personal exemptions:
............................................................................................................................. 28
See instructions
00
29 Arizona taxable income:
............................................................................................ 29
Subtract lines 27 and 28 from line 26
00
30 Tax from tax table:
Table X or Y (140, 140NR or 140PY)
Optional Table (140, 140A or 140EZ) ................... 30
00
31 Tax from recapture of credits from Arizona Form 301, Part 2, line 40 ............................................................................ 31
00
32 Subtotal of tax:
.................................................................................................................................. 32
Add lines 30 and 31
00
33 Family income tax credit (Arizona residents only) .......................................................................................................... 33
00
34 Credits from Arizona Form 301, Part 2, line 76 .............................................................................................................. 34
00
35 Balance of tax:
.............................................................. 35
Subtract lines 33 and 34 from line 32. If less than zero, enter “zero”
00
36 Payments (withholding, estimated, or extension) ........................................................................................................... 36
00
37 Increased Excise Tax Credit (Arizona residents only) .................................................................................................... 37
00
38 Property Tax Credit (Arizona residents only) .................................................................................................................. 38
00
39 Other refundable credits:
......................
1
308-I
2
342
3
349 39
Check the box(es) and enter the total amount
39
39
39
00
40 Payment with original return plus all payments after it was filed .................................................................................... 40
00
41 Total payments and refundable credits:
................................................................................. 41
Add lines 36 through 40
00
42 Overpayment from original return or as later adjusted.
.......................................................................... 42
See instructions
00
43 Balance of credits:
................................................................................................................. 43
Subtract line 42 from line 41
00
44 OVERPAYMENT:
.......................... 44
If line 35 is less than line 43, subtract line 35 from line 43 and enter amount of overpayment
00
45 Amount of line 44 to be applied to 2016 estimated tax. If zero, enter “0” ...................................................................... 45
00
46 REFUND:
......................................................... 46
Subtract line 45 from line 44. If less than zero, enter amount owed on line 47
A
A
Direct Deposit of Refund: Check box
if your deposit will be ultimately placed in a foreign account; see instructions.
46
46
ROUTING NUMBER
ACCOUNT NUMBER
C
Checking or
98
S
Savings
47 AMOUNT OWED:
If line 35 is more than line 43, subtract line 43 from line 35, and enter the amount owed.
00
Make check payable to Arizona Department of Revenue; write your SSN on payment, and include with your return .. 47
2
0
Y
Y
48 Check box 48 if this amended return is the result of a net operating loss, and enter the year the loss was incurred .... 48
Form 140X (2015)
Page 1 of 3
ADOR 10573 (15)
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