Arizona Form 140py - Part-Year Resident Personal Income Tax Return - 2014
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1
2
3Arizona Form
FOR CALENDAR YEAR
Part-Year Resident Personal Income Tax Return
2014
140PY
Check box 82F
M M D D
2 0 1 4
M M D D
2 0
Y Y
82F
if filing under extension
OR FISCAL YEAR BEGINNING
AND ENDING
.
66F
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)
2
94
City, Town or Post Office
State
ZIP Code
Last Names Used in Last Four Prior Year(s) (if different)
3
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
4
Married filing joint return
88R
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 put a check mark.
PM
RCVD
8
Age 65 or over (you and/or spouse)
81P
80R
If completing lines 8
9
Blind (you and/or spouse)
through 11, also complete
10
Dependents:
Do not include self or spouse.
lines 49 through 54.
11
Qualifying parents and grandparents
12-13
Residency Status
: 12
Part-Year Resident Other than Active Military
13
Part-Year Resident Active Military
(check one)
(Box 10): Dependent Information: Children and other dependents. For more space, (check)
and complete page 3.
(a)
(b)
(c)
(d)
(e)
(f)
if this person
if you did not claim
NO. OF MONTHS
FIRST AND LAST NAME
SOCIAL SECURITY NO.
RELATIONSHIP
did not qualify as a
this person on your
LIVED IN YOUR
(Do not list yourself or spouse.)
dependent on your
federal return due to
HOME IN 2014
federal return
educational credits
10
a
10
b
(Box 11): Qualifying parents and grandparents. See instructions. For more space, (check)
and complete page 3.
(a)
(b)
(c)
(d)
(e)
(f)
FIRST AND LAST NAME
SOCIAL SECURITY NO.
RELATIONSHIP
NO. OF MONTHS
if
if
LIVED IN YOUR
(Do not list yourself or spouse.)
age 65 or over
died in 2014
HOME IN 2014
11
a
11
b
M M D D Y Y Y Y
M M D D Y Y Y Y
14
to
Dates of Arizona residency: From
2014 FEDERAL
2014 ARIZONA
Amount from Federal Return
Amount Only
List other state(s) of residency:
00
00
15 Wages, salaries, tips, etc. ................................................................................................... 15
00
00
16 Interest................................................................................................................................. 16
00
00
17 Dividends ............................................................................................................................. 17
00
00
18 Arizona income tax refunds ................................................................................................. 18
00
00
19 Alimony received ................................................................................................................. 19
00
00
20 Business income (or loss) from federal Schedule C............................................................ 20
00
00
21 Gains (or losses) from federal Schedule D.......................................................................... 21
00
00
22
22
Rents, royalties, partnerships, estates, trusts, small business corporations from federal Schedule E....
00
00
23 Other income reported on your federal return ..................................................................... 23
00
00
24 Total income:
.................................................................................... 24
Add lines 15 through 23
00
00
25 Other federal adjustments:
........................................................... 25
Include your own schedule
00
26 Federal adjusted gross income:
.............. 26
Subtract line 25 from line 24 in the FEDERAL column
00
27 Arizona income:
.............................................................................. 27
Subtract line 25 from line 24 in the ARIZONA column
%
28 Arizona percentage:
.......................................................... 28
Divide line 27 by line 26, and enter the result (not over 100%)
00
29 Total depreciation included in Arizona gross income .................................................................................................. 29
00
30 Other additions to income:
...................................................... 30
See instructions on page 8 and include your own schedule
00
31 Subtotal:
................................................................................................................................ 31
Add lines 27, 29, and 30
00
32 Total Arizona sourced net capital gain or (loss) ................................................................... 32
00
33 Total net short-term capital gain or (loss) included on line 21, ARIZONA column ............... 33
00
34 Total net long-term capital gain or (loss):
34
Enter the amount from your worksheet, line 14, col. (c)
35 Net long-term capital gain from assets acquired after December 31, 2011.
Enter the amount
00
.......................................................................................... 35
from your worksheet, line 14, col. (e)
00
36 Multiply line 35 by 20% (.20) and enter the result ...................................................................................................... 36
00
37 Net capital gain derived from investment in qualified small business......................................................................... 37
00
38 Contributions to 529 College Savings Plans .............................................................................................................. 38
00
39 Subtract lines 36, 37, and 38 from line 31. Enter the difference ................................................................................ 39
AZ Form 140PY (2014)
Page 1 of 3
ADOR 10149 (14)
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