Arizona Form 165 - Arizona Partnership Income Tax Return - 2014 Page 3
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1
2
3Name (as shown on page 1)
EIN
SCHEDULE E
Partner Information
Prepare a schedule that lists each partner’s name, address, taxpayer identification number, and pro rata share of the amount shown on line 5. Label
the listing as “Schedule E: Partner Information” and include the schedule immediately after page 3 of Form 165.
I, the undersigned partner of the partnership for which this return is made, declare under penalty of perjury, that this return, including
the accompanying schedules and statements, has been examined by me and is to the best of my knowledge and belief, a correct and
Declaration
complete return, made in good faith, for the taxable year stated pursuant to the income tax laws of the State of Arizona.
Please
Sign
Here
PARTNER’S SIGNATURE
DATE
TITLE
PAID PREPARER’S SIGNATURE
DATE
PAID PREPARER’S PTIN
Paid
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
Include federal Form 1065, federal Schedules K-1 (Form 1065), and all supporting schedules with this return.
Mail to: Arizona Department of Revenue, PO Box 52153, Phoenix, AZ 85072-2153
Print
ADOR 10343 (14)
AZ Form 165 (2014)
Page 3 of 3
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