Arizona Form 140nr - Nonresident Personal Income Tax Return - 2015 Page 2
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1
2
3
4Return to Page 1
Your Name (as shown on page 1)
Your Social Security Number
0
00
42 Enter the amount from page 1, line 41 .......................................................................................................................... 42
00
43 Interest on U.S. obligations such as U.S. savings bonds and treasury bills .................................................................. 43
00
44 Arizona state lottery winnings included as income on your federal return (up to $5,000 only) ..................................... 44
00
45 Agricultural crops contributed to Arizona charitable organizations ................................................................................ 45
00
46 Other subtractions:
.................................................................................... 46
See instructions and include your own schedule
00
47 Age 65 or over:
............................................................... 47
Multiply the number in box 8 by $2,100
00
48 Blind:
.............................................................................. 48
Multiply the number in box 9 by $1,500
00
49 Dependents:
................................................................. 49
Multiply the number in box 10 by $2,300
00
0
50 Add lines 47, 48, and 49 and enter the total ............................................................................ 50
0
00
51 Multiply line 50 by the Arizona ratio on line 27 .............................................................................................................. 51
0
00
52 Arizona adjusted gross income:
........................................................... 52
Subtract lines 43 through 46 and 51 from line 42
I
S
Sch A
00
53 Deductions: Check box and enter amount.
.......................
ITEMIZED
STANDARD 53
See instructions
53
53
Select Personal Exemptions
00
54 Personal exemptions:
............................................................................................................................ 54
See instructions
0
00
55 Arizona taxable income:
........................................................................................... 55
Subtract lines 53 and 54 from line 52
X&Y Tax Table
00
56 Compute the tax using amount from line 55 and Tax Table X or Y ................................................................................ 56
Credit 301
0
00
57 Tax from recapture of credits from Arizona Form 301, Part 2, line 40 ........................................................................... 57
0
00
58 Subtotal of tax:
...................................................................................................... 58
Add lines 56 and 57 and enter the total
00
59 Credits from Arizona Form 301, Part 2, line 76 ............................................................................................................. 59
00
60 Balance of tax:
......................................................... 60
Subtract line 59 from line 58. If line 59 is more than line 58, enter zero
00
61 Arizona income tax withheld during 2015 ...................................................................................................................... 61
No Withholding? Click this button
00
62 Arizona estimated tax payments for 2015 ..................................................................................................................... 62
00
63 2015 Arizona extension payment (Form 204)................................................................................................................ 63
00
64 Other refundable credits:
1
308-I
2
342
3
349 64
Check the box(es) and enter the total amount ........................
64
64
64
0
00
65 Total payments and refundable credits:
...................................................... 65
Add lines 61 through 64 and enter the total
00
66 TAX DUE:
...... 66
If line 60 is larger than line 65, subtract line 65 from line 60, and enter amount of tax due. Skip lines 67, 68 and 69
00
67 OVERPAYMENT:
...................... 67
If line 65 is larger than line 60, subtract line 60 from line 65, and enter amount of overpayment
00
68 Amount of line 67 to be applied to 2016 estimated tax.................................................................................................. 68
00
69 Balance of overpayment:
...................................................................................................... 69
Subtract line 68 from line 67
Solutions Teams
00
00
70 - 79 Voluntary Gifts to:
71
70
Arizona Wildlife ...............
Assigned to Schools ...........
00
00
00
72
73
74
Child Abuse Prevention ...........
Domestic Violence Shelter .
Political Gift.....................
00
00
00
75
76
77
Neighbors Helping Neighbors..
Special Olympics ................
Veterans’ Donations Fund
Sustainable State Parks
00
00
78
I Didn’t Pay Enough Fund........
79
and Road Fund ...................
80 Political Party
1
2
3
4
5
(if amount is entered on line 74 - check only one):
80
Americans Elect 80
AZ Green Party 80
Democratic 80
Libertarian 80
Republican
00
81 Estimated payment penalty and Arizona Long-Term Health Care Saving Account (AZLTHSA) penalty ....................... 81
82
1
2
3
4
Annualized/Other
Farmer or Fisherman
Form 221 included
AZLTHSA Penalty
82
82
82
82
00
83 Add lines 70 through 79 and 81; enter the total............................................................................................................. 83
00
84 REFUND:
......................................................... 84
Subtract line 83 from line 69. If less than zero, enter amount owed on line 85
A
A
Direct Deposit of Refund: Check box
if your deposit will be ultimately placed in a foreign account; see instructions.
84
84
ROUTING NUMBER
ACCOUNT NUMBER
C
Checking or
98
S
Savings
00
85 AMOUNT OWED:
... 85
Add lines 66 and 83. Make check payable to Arizona Department of Revenue; write your SSN on payment
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 140NR (2015)
Page 2 of 3
ADOR 10177 (15)
Return to Page 1
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