Arizona Form 140a - Resident Personal Income Tax Return (Short Form) Page 2

Download a blank fillable Arizona Form 140a - Resident Personal Income Tax Return (Short Form) in PDF format just by clicking the "DOWNLOAD PDF" button.

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Complete Arizona Form 140a - Resident Personal Income Tax Return (Short Form) with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

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Your Name (as shown on page 1)

Your Social Security Number

31 Enter the amount from page 1, line 29 (Tax Due) or 30 (Overpayment) ........................................................................ 31

Solutions Teams

32 - 41 Voluntary Gifts to:

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

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

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

Domestic Violence Shelter .

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

Neighbors Helping Neighbors..

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

Veterans’ Donations Fund

Sustainable State

I Didn’t Pay Enough Fund........

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

42 Political Party

(if amount is entered on line 36 - check only one box):



Americans Elect 42

AZ Green Party 42

Democratic 42

Libertarian 42

Republican

43 Total voluntary gifts:

..................................................................................................................... 43

Add lines 32 through 41

44 REFUND: If line 31 is an overpayment, subtract line 43 from line 31.

....... 44

If less than zero, enter amount owed on line 45



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

45 AMOUNT OWED: If line 31 is a tax due, add lines 31 and 43.

Make check payable to Arizona Department of Revenue;

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

write your SSN on payment, and include with your return

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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).

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MAILING INSTRUCTIONS

Mail your return to the P. O. Box listed above

for barcode forms (P. O. Box 29204 or 29205).

Using the correct P. O. Box speeds up the

handling of your return.

AZ Form 140A (2015)

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ADOR 10414 (15)