Form 120a - Arizona Corporation Income Tax Return (Short Form) - 2013 Page 2
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1
2Name (as shown on page 1)
EIN
Schedule A – Additions to Taxable Income
00
A1 Total federal depreciation ................................................................................................................................................
A1
A2 Reserved ........................................................................................................................................................................
A2
00
A3 Taxes based on income paid to any state (INCLUDING ARIZONA), local governments or foreign governments .........
A3
00
A4 Interest on obligations of other states, foreign countries, or political subdivisions .........................................................
A4
00
A5 Special deductions claimed on federal return .................................................................................................................
A5
00
A6 Federal net operating loss deduction claimed on federal return .....................................................................................
A6
00
A7 Commissions and other expenses paid or accrued to a Domestic International Sales Corporation (DISC) ..................
A7
00
A8 Capital investment by certified defense contractor – attach schedule ............................................................................
A8
00
A9 Additions related to Arizona tax credits – attach schedule .............................................................................................
A9
00
A10 Other additions to federal taxable income – attach schedule ......................................................................................... A10
00
A11 Total – add lines A1 through A10. Enter total here and on page 1, line 2 ...................................................................... A11
Schedule B – Subtractions From Taxable Income
00
B1 Recalculated Arizona depreciation – see instructions ....................................................................................................
B1
00
B2 Basis adjustment for property sold or otherwise disposed of during the taxable year – see instructions .......................
B2
00
B3 Adjustment for IRC § 179 expense not allowed ..............................................................................................................
B3
00
B4 Dividends received from 50% or more controlled domestic corporations .......................................................................
B4
00
B5 Foreign dividend gross-up ..............................................................................................................................................
B5
00
B6 Dividends received from foreign corporations ................................................................................................................
B6
00
B7 Dividends received from a DISC .....................................................................................................................................
B7
00
B8 Interest on U.S. obligations .............................................................................................................................................
B8
00
B9 Agricultural crops charitable contribution ........................................................................................................................
B9
00
B10 Capital investment by certified defense contractor – attach schedule ............................................................................ B10
00
B11 Other subtractions from federal taxable income – attach schedule ................................................................................ B11
00
B12 Total – add lines B1 through B11. Enter total here and on page 1, line 4 ...................................................................... B12
Schedule C – Additional Information
M M D D Y Y Y Y
C1 Date business began in Arizona:
C2 Address at which tax records are located for audit purposes: Number/Street:
City:
State:
ZIP Code:
C3 The taxpayer designates the individual listed below as the person to contact to schedule an audit of this return and authorizes the disclosure of
confidential information to this individual. (See instructions, page 11.)
Name:
Phone number:
Title:
C4 List prior taxable years for which a federal examination has been finalized:
NOTE: A.R.S. § 43-327 requires the taxpayer, within ninety days after final determination, to report these changes under separate cover to the
Arizona Department of Revenue or to file amended returns reporting these changes. (See instructions, page 3.)
$
00
C5 Amount of Arizona taxable income for prior taxable year (2012 Form 120A, line 7) .........................................................
C6 Indicate tax accounting method:
Cash
Accrual
Other (Specify method.)
The following declaration must be signed by one or more of the following officers: president, treasurer, or any other principal officer.
Declaration
Under penalties of perjury, I(we), the undersigned officer(s) authorized to sign this return, declare that I(we) have examined this return,
including the accompanying schedules and statements, and to the best of my(our) knowledge and belief, it is a true, correct and
complete return, made in good faith, for the taxable year stated pursuant to the income tax laws of the State of Arizona.
Please
OFFICER’S SIGNATURE
DATE
TITLE
Sign
Here
OFFICER’S SIGNATURE
DATE
TITLE
Paid
PAID PREPARER’S SIGNATURE
DATE
PAID PREPARER’S PTIN
Preparer’s
FIRM’S NAME (OR PAID PREPARER’S NAME, IF SELF-EMPLOYED)
FIRM’S
EIN OR
SSN
Use
Only
FIRM’S STREET ADDRESS
FIRM’S TELEPHONE NUMBER
CITY
STATE
ZIP CODE
Mail to: Arizona Department of Revenue, PO Box 29079, Phoenix, AZ 85038-9079
ADOR 10949 (13)
AZ Form 120A (2013)
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