Arizona Form 140py - Part-Year Resident Personal Income Tax Return - 2015 Page 3
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4Return to Page 1
Your Name (as shown on page 1)
Your Social Security Number
Dependent Information - Continuation Sheet
from Page 1 Dependents
Include with your return only if listing additional dependents.
Complete this form only if you need additional space from page 1 to list your dependents.
If you do not list all dependents claimed on page 1 of your income tax return, you may lose the exemptions.
Children and other dependents, continued from page 1.
(a)
(b)
(c)
(d)
(e)
(f)
NO. OF MONTHS
FIRST AND LAST NAME
SOCIAL SECURITY NO.
RELATIONSHIP
if this person
if you did not claim
LIVED IN YOUR
did not qualify as a
this person on your
(Do not list yourself or spouse.)
dependent on your
federal return due to
HOME IN 2015
federal return
educational credits
10
c
10
d
10
e
10
f
10
g
10
h
10
i
10
j
10
k
10
l
10
m
10
n
10
o
10
p
10
q
10
r
10
s
10
t
Qualifying parents and grandparents, continued from page 1.
(a)
(b)
(c)
(d)
(e)
(f)
NO. OF MONTHS
FIRST AND LAST NAME
SOCIAL SECURITY NO.
RELATIONSHIP
if
if
LIVED IN YOUR
(Do not list yourself or spouse.)
age 65 or over
died in 2015
HOME IN 2015
11
c
11
d
11
e
11
f
11
g
11
h
11
i
11
j
Return to Page 1
AZ Form 140PY (2015)
ADOR 10149 (15)
Page 3 of 3
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