Arizona Form 140 - Resident Personal Income Tax Return - 2013 Page 6
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28Arizona Form 140
Line 10 (Box) - Dependents
Lines A3a and A3b - Persons You Did Not Take
as Dependents on Your Federal Return
You must complete Part A, lines A1 through A3b, on page 2 of
your return before you can total your dependent exemptions.
On line A3a, enter the following.
You may claim only the following as a dependent.
1. The names of any dependents age 65 or over listed on
A person that qualifies as your dependent on your federal
line(s) A1 that you cannot take as a dependent on your
return.
federal return.
NOTE: If you do not claim a dependent exemption for a
2. The name of any stillborn child listed on line(s) A1, if
student on your federal return in order to allow the student
the stillborn child was named. If the stillborn child was
to claim a federal education credit on the student’s federal
not named, enter “stillborn child” on line A3a. Also
return, you may still claim the exemption on your Arizona
enter the date of birth resulting in the stillbirth.
return. For more information, see Arizona Individual
Income Tax Ruling ITR 05-2.
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 return
A person who is age 65 or over (related to you or not)
in order to allow that student to claim a federal education
that does not qualify as your dependent on your federal
credit on the student’s federal return.
return, but one of the following applies.
Line 11 (Box) - Qualifying Parents and Grandparents
1. In 2013, you paid more than one-fourth of the cost
A qualifying parent or grandparent may be any one of the
of keeping this person in an Arizona nursing care
following.
institution, an Arizona residential care institution,
or an Arizona assisted living facility. Your cost
Your parent or your grandparent. This can be your
grandparent, great grandparent, etc.
must be more than $800.
2. In 2013, you paid more than $800 for either
If married filing a joint return, your spouse’s parent,
grandparent, or great grandparent, etc.
Arizona home health care or other medical costs for
the person.
You may claim this exemption if all of the following apply.
1. The parent or grandparent lived in your principal
A stillborn child if the following apply.
residence for the entire taxable year.
1. The stillbirth occurred during 2013.
2. You paid more than one-half of the support and
2. You received a certificate of birth resulting in
maintenance costs of the parent or grandparent during
stillbirth from the Arizona Department of Health
Services.
the taxable year.
3. The parent or grandparent was 65 years old or older
3. The child would have otherwise been a member of
during 2013.
your household.
4. The parent or grandparent required assistance with
Part A:
Dependents, Qualifying Parents
activities of daily living, like getting in and out of bed or
and Grandparents (page 2 of the return)
chairs, walking around, going outdoors, using the toilet,
bathing, shaving, brushing teeth, combing hair,
dressing, medicating or feeding.
Completing Line(s) A1
You must complete Part A, lines A4 and A5, on page 2 of
NOTE: If a person who qualifies as your dependent is also a
your return before you can total your exemptions for
qualifying parent or grandparent, you may claim that person
qualifying parents and grandparents.
as a dependent on line A2, or you may claim that person as a
NOTE: If a person who is a qualifying parent or
qualifying parent or grandparent on line A5. You may not
grandparent also qualifies as your dependent, you may
claim that same person on both line A2 and line A5. Do not
claim that person as a dependent on line A2, or you may
list the same person on line A1 that you listed on line A4.
claim that person as a qualifying parent or grandparent on
line A5. You may not claim that same person on both line A2
Enter the following on line(s) A1.
and line A5. Do not list the same person on line A4 that you
1. The dependent's name. If you are claiming an
listed on line A1.
exemption for a stillborn child and the child was not
Completing Line(s) A4
named, enter “stillborn child” in place of a name.
Enter the following on line(s) A4.
2. The dependent's SSN. If you are claiming an exemption
for a stillborn child enter the certificate number from the
1.
The name of the qualifying parent or grandparent.
certificate of birth resulting in stillbirth.
2. The SSN of the qualifying parent or grandparent.
3. The qualifying parent’s or grandparent’s relationship to
3. The dependent's relationship to you.
you, or your spouse if filing a joint return.
4. The number of months the dependent lived in your home
4. The number of months the qualifying parent or
during 2013. If you are claiming an exemption for a stillborn
grandparent lived in your home during 2013.
child, enter the date of birth resulting in the stillbirth.
You may lose the exemption if you do not furnish this
You may lose the exemption if you do not furnish this
information.
information.
Line
A5
-
Total
Qualifying
Parents
or
Line A2 - Total Dependents
Grandparents
Enter the total number of persons listed on line(s) A1. Enter
Enter the total number of persons listed on line(s) A4. Enter
the same number on the front of the return in box 10.
the same number on the front of the return in box 11.
6
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