Arizona Form 140 - Resident Personal Income Tax Return - 2015 Page 2

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Your Name (as shown on page 1)

Your Social Security Number

37 Enter the amount from page 1, line 36 ........................................................................................................................... 37

38 Age 65 or over:

....................................................................................................... 38

Multiply the number in box 8 by $2,100

39 Blind:

...................................................................................................................... 39

Multiply the number in box 9 by $1,500

40 Dependents:

......................................................................................................... 40

Multiply the number in box 10 by $2,300

41 Qualifying parents and grandparents:

..................................................................................... 41

Multiply box 11 by $10,000

42 Arizona adjusted gross income:

...................................................................... 42

Subtract lines 38 through 41 from line 37



Sch A

43 Deductions: Check box and enter amount.

........................

ITEMIZED

STANDARD 43

See instructions

Select Personal Exemption

44 Personal exemptions:

............................................................................................................................. 44

See instructions

45 Arizona taxable income:

........................................................................................... 45

Subtract lines 43 and 44 from line 42.

Opt Tax Table

46 Compute the tax using amount on line 45 and Tax Table X, Y or Optional Tax Tables ................................................... 46

Credit 301

X&Y Tax Table

47 Tax from recapture of credits from Arizona Form 301, Part 2, line 40 ............................................................................ 47

48 Subtotal of tax:

....................................................................................................... 48

Add lines 46 and 47 and enter the total

49 Family income tax credit

.......................................................................................... 49

(from the worksheet - see instructions)

50 Credits from Arizona Form 301, Part 2, line 76 .............................................................................................................. 50

51 Balance of tax:

.................. 51

Subtract lines 49 and 50 from line 48. If the sum of lines 49 and 50 is more than line 48, enter zero

52 Arizona income tax withheld during 2015 ....................................................................................................................... 52

53 Arizona estimated tax payments for 2015 ...................................................................................................................... 53

54 2015 Arizona extension payment (Form 204)................................................................................................................. 54

55 Increased Excise Tax Credit

.................................................................................... 55

(from the worksheet - see instructions)

56 Property Tax Credit from Form 140PTC ......................................................................................................................... 56



57 Other refundable credits:

.......................

308-I

342

349 57

Check the box(es) and enter the total amount

58 Total payments and refundable credits:

....................................................... 58

Add lines 52 through 57 and enter the total

59 TAX DUE:

........ 59

If line 51 is larger than line 58, subtract line 58 from line 51 and enter amount of tax due. Skip lines 60, 61 and 62

60 OVERPAYMENT:

........................ 60

If line 58 is larger than line 51, subtract line 51 from line 58 and enter amount of overpayment

61 Amount of line 60 to be applied to 2016 estimated tax................................................................................................... 61

62 Balance of overpayment:

.................................................................... 62

Subtract line 61 from line 60 and enter the difference

Solutions Teams

63 - 72 Voluntary Gifts to:

Arizona Wildlife ...............

Assigned to Schools ...........

Domestic Violence Shelter .

Political Gift.....................

Child Abuse Prevention ...........

Neighbors Helping Neighbors..

Special Olympics ................

Veterans’ Donations Fund

Sustainable State Parks

I Didn’t Pay Enough Fund........

and Road Fund ...................



73 Political Party

(if amount is entered on line 67 - check only one):

Americans Elect 73

AZ Green Party 73

Democratic 73

Libertarian 73

Republican

74 Estimated payment penalty and Arizona Long-Term Health Care Savings Account (AZLTHSA) penalty ...................... 74



Annualized/Other

Farmer or Fisherman

Form 221 included

AZLTHSA Penalty

76 Add lines 63 through 72 and 74; enter the total.............................................................................................................. 76

77 REFUND:

.......................................................... 77

Subtract line 76 from line 62. If less than zero, enter amount owed on line 78



Direct Deposit of Refund: Check box

if your deposit will be ultimately placed in a foreign account; see instructions.

ROUTING NUMBER

ACCOUNT NUMBER



Checking or



Savings

78 AMOUNT OWED:

Add lines 59 and 76.

Make check payable to Arizona Department of Revenue; write your SSN on payment,

................................................................................................................................................. 78

and include with your return

Return to Page 1

Under penalties of perjury, I declare that I have read this return and any documents with it, and to the best of my knowledge and belief, they are

true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.



YOUR SIGNATURE

DATE

OCCUPATION



SPOUSE’S SIGNATURE

DATE

SPOUSE’S OCCUPATION

PAID PREPARER’S SIGNATURE

DATE

FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED)

PAID PREPARER’S STREET ADDRESS

PAID PREPARER’S TIN

PAID PREPARER’S CITY

STATE

ZIP CODE

PAID PREPARER’S PHONE NUMBER

If you are also sending a payment, mail to Arizona Department of Revenue, PO Box 52016, Phoenix, AZ 85072-2016 (PO Box 29204, Phoenix, AZ 85038-9204 if your return has a barcode).

If you are not sending a payment, mail to Arizona Department of Revenue, PO Box 52138, Phoenix, AZ 85072-2138 (PO Box 29205, Phoenix, AZ 85038-9205 if your return has a barcode).

AZ Form 140 (2015)

ADOR 10413 (15)

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