Arizona Form 141az - Arizona Fiduciary Income Tax Return - 2013 Page 4
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1
2
3
4Name of Estate or Trust (as shown on page 1)
Employer Identification Number
SCHEDULE E: Questions
E1 Check the box if this return is for a short taxable year .....................................................................................................
YES
NO
E2 Have Arizona income tax returns been filed for the four (4) years preceding date of death? ..........................................
If “No”, please explain:
m m D D Y Y Y Y
E3 Date of decedent’s death or date the trust was established ............................................
YES
NO
E4 Was a fiduciary return filed the preceding year?..............................................................................................................
CASH
ACCRUAL
E5 Check the box to indicate whether this return was prepared on a cash or accrual basis: ...............................................
E6 Has the federal government made an additional assessment on the income of this estate in the last
YES
NO
four (4) years? .................................................................................................................................................................
If “Yes”, submit a detailed report with this return.
E7 If return is for a trust, enter the name and address of the grantor:
PLEASE SIGN BELOW
I declare under the penalties of perjury that this return, including any accompanying schedules and statements, has been examined
by me, and to the best of my knowledge and belief is a true, correct and complete return.
SIgNATURE OF FIDUCIARY OR
DATE
PAID PREPARER’S SIgNATURE
DATE
OFFICER REPRESENTINg FIDUCIARY
SIgNATURE OF PERSON OTHER THAN
DATE
FIRm NAmE OF PAID PREPARER (PREPARER’S NAmE IF SELF-EmPLOYED)
TAxPAYER OR AgENT
STREET ADDRESS OF FIDUCIARY OR OFFICER
STREET ADDRESS OF PAID PREPARER
CITY
STATE ZIP CODE
CITY
STATE ZIP CODE
EmPLOYER OR FIRm NAmE OF FIDUCIARY/OFFICER, IF ANY
PHONE NO. (include area code)
PAID PREPARER’S TIN
• If you are sending a payment with this return, mail to:
Arizona Department of Revenue, PO Box 52016, Phoenix, AZ, 85072-2016.
• If you are expecting a refund or owe no tax, or owe tax but are not sending a payment, mail to:
Arizona Department of Revenue, PO Box 52138, Phoenix, AZ, 85072-2138.
NOTE: If an estate is being probated, the fiduciary may have to obtain a certificate from the department that
shows no income tax is due. See page 3 of the instructions for details. make requests for an income tax certificate
separately. Do not attach requests for the income tax certificate to Form 141AZ.
Print Form
ADOR 10584 (13)
AZ Form 141AZ (2013)
Page 4 of 4
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