Arizona Form 140py - Part-Year Resident Personal Income Tax Return - 2013 Page 5
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29Arizona Form 140PY
an Arizona assisted living facility. Your cost must be
Line 7 Box - Single
more than $800.
If you are filing as single, check box 7.
2. In 2013, you paid more than $800 for either
Use this filing status if you were single on December 31,
Arizona home health care or other medical costs for
2013. You are single if any of the following apply to you.
the person.
You have never been married.
A stillborn child if the following apply:
You are legally separated under a decree of divorce or
1. The stillbirth occurred in Arizona during 2013.
of separate maintenance.
2. You received a certificate of birth resulting in
You were widowed before January 1, 2013, and you did
stillbirth from the Arizona Department of Health
not remarry in 2013, and you do not qualify to file as a
Services.
qualifying widow or widower with dependent children
3. The child would have otherwise been a member of
on your federal return.
your household.
Exemptions
Part A – Dependents, Parents and Grandparents
Enter the number of exemptions you are claiming in boxes 8,
Completing Line(s) A1
9, 10, and 11. Do not put a check mark. You may lose the
NOTE: If a person who qualifies as your dependent is also
exemption if you put a checkmark in these boxes.
a qualifying parent or grandparent, you may claim that
You may lose the dependent exemption if you do not
person as a dependent on line A2, or you may claim that
complete Part A, lines A1 through A3b on page 2. You may
person as a qualifying parent or grandparent on line A5.
You may not claim that same person on both line A2 and
lose the exemption for qualifying parents and grandparents if
line A5. Do not list the same person on line A1 that you
you do not complete Part A, lines A4 and A5, on page 2.
listed on line A4.
Line 8 Box - Age 65 and Over
Enter the following on line(s) A1.
Enter "1" in box 8 if you or your spouse were 65 or older in
1. The dependent's name.
If you are claiming an
2013. Enter "2" in box 8 if both you and your spouse were
exemption for a stillborn child and the child was not
65 or older in 2013.
named, enter “stillborn child” in place of a name.
Line 9 Box - Blind
2. The dependent's SSN. If you are claiming an exemption
for a stillborn child enter the certificate number from the
Enter "1" in box 9 if you or your spouse is totally or partially
certificate of birth resulting in stillbirth.
blind. Enter "2" in box 9 if both you and your spouse are totally
3. The dependent's relationship to you.
or partially blind.
4. The number of months the dependent lived in your
If you or your spouse were partially blind as of December
home during 2013. If you are claiming an exemption
31, 2013, you must get a statement certified by your eye
for a stillborn child, enter the date of birth resulting in
doctor or registered optometrist that:
the stillbirth.
1. You cannot see better than 20/200 in your better eye with
You may lose the exemption if you do not furnish this
glasses or contact lenses or
information.
2. Your field of vision is 20 degrees or less.
Line A2 - Total Dependents
If your eye condition is not likely to improve beyond the
Enter the total number of persons listed on line(s) A1. Enter
conditions listed above, you can get a statement certified by
the same number on the front of the return in box 10.
your eye doctor or registered optometrist to that effect instead.
Lines A3a and A3b - Persons You Did Not Take
You must keep the statement for your records.
as Dependents on Your Federal Return
Line 10 Box - Dependents
On line A3a, enter the following.
You must complete Part A, lines A1 through A3b, on page 2 of
1. The names of any dependents age 65 or over listed on
your return before you can total your dependent exemptions.
line(s) A1 that you cannot take as a dependent on your
federal return.
NOTE: If you do not claim a dependent exemption for a
student on your federal return in order to allow the student
2. The name of any stillborn child listed on line(s) A1, if
to claim a federal education credit on the student’s federal
the stillborn child was named. If the stillborn child was
return, you may still claim the exemption on your Arizona
not named, enter “stillborn child” on line A3a. Also
return. For more information, see Individual Income Tax
enter the date of birth resulting in the stillbirth.
Ruling ITR 05-02.
On line A3b, enter the name of any student listed on line(s)
A1, that you did not claim as an exemption on your federal
You may claim only the following as a dependent.
return in order to allow that student to claim a federal
A person that qualifies as your dependent on your
education credit on the student’s federal return.
federal return.
Line 11 Box - Qualifying Parents and
A person who is age 65 or over (related to you or not)
Grandparents
that does not qualify as your dependent on your federal
return, but one of the following applies.
A qualifying parent or grandparent may be any one of the
following.
1.
In 2013, you paid more than one-fourth of the cost of
keeping this person in an Arizona nursing care
Your parent or your grandparent, great grandparent,
institution, an Arizona residential care institution, or
great great grandparent, etc.
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