Arizona Form 140 - Resident Personal Income Tax Return - 2012

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ARIZONA FORM

FOR

Resident Personal Income Tax Return

CALENDAR YEAR

140

2012

. 66

M M D D Y Y Y Y

OR FISCAL YEAR BEGINNING

AND ENDING

Check box 82F if filing under extension

82F

Your First Name and Middle Initial

Last Name

Your Social Security No.

Enter

your

Spouse’s First Name and Middle Initial (if box 4 or 6 checked)

Last Name

Spouse’s Social Security No.

SSN(s).

Current Home Address - number and street, rural route

Apt. No.

Daytime Phone (with area code)

Home Phone (with area code)

City, Town or Post Office

State Zip Code

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

Married filing joint return

NAME OF QUALIFYING CHILD OR DEPENDENT

Head of household ......►

Married filing separate return. Enter spouse’s name and Social Security No. above.

Single

Enter the number claimed. Do not put a check mark.

Age 65 or over (you and/or spouse)

Blind (you and/or spouse)

Dependents.

From page 2, line A2 – do not include self or spouse.

Qualifying parents and grandparents.

From page 2, line A5.

12 Federal adjusted gross income

.....................................................................................................

(from your federal return)

13 Additions to income

..........................................................................................................................

(from page 2, line B12)

14 Subtractions from income

(from page 2, line C17 or line C30) ...............................................................................................................

15 Arizona adjusted gross income.

.........................................................................

Add lines 12 and 13 then subtract line 14

16 Deductions: Check box and enter amount.

...

ITEMIZED

STANDARD 16

See instructions, pages 14 and 15

17 Personal exemptions.

...........................................................................................................

See page 15 of the instructions

18 Arizona taxable income:

......................................................

Subtract lines 16 and 17 from line 15. If less than zero, enter zero

19 Compute the tax using amount on line 18 and Tax Table X, Y or Optional Tax Tables ......................................................

20 Tax from recapture of credits from Arizona Form 301, Part II, line 35 ...............................................................................

21 Subtotal of tax:

.....................................................................................................................................

Add lines 19 and 20

22 Family income tax credit

......................................................................................

(from worksheet on page 16 of instructions)

23 Credits from Arizona Form 301, Part II, line 68, or Forms 310, 321, 322, and 323 if Form 301 is not required ................

24 Credit type:

..............

Enter form number of each credit claimed

25 Clean Elections Fund Tax Credit for donations made prior to August 2, 2012

(from worksheet on page 18 of the instructions)

26 Balance of tax:

...........

Subtract lines 22, 23 and 25 from line 21. If the sum of lines 22, 23 and 25 is more than line 21, enter zero

27 Arizona income tax withheld during 2012 ..........................................................................................................................

28 Arizona estimated tax payments for 2012 .........................................................................................................................

29 2012 Arizona extension payment (Form 204) ....................................................................................................................

30 Increased Excise Tax Credit

...................................................

(from Form 140PTC or worksheet on page 19 of the instructions)

31 Property Tax Credit from Form 140PTC ............................................................................................................................

32 Other refundable credits: Check the box(es) and enter the amount .........................

Form 308-I

Form 342 32

33 Total payments/refundable credits:

............................................................................................

Add lines 27 through 32

34 TAX DUE:

...........

If line 26 is larger than line 33, subtract line 33 from line 26 and enter amount of tax due. Skip lines 35, 36 and 37

35 OVERPAYMENT:

...........................

If line 33 is larger than line 26, subtract line 26 from line 33 and enter amount of overpayment

36 Amount of line 35 to be applied to 2013 estimated tax ......................................................................................................

37 Balance of overpayment:

..........................................................................................................

Subtract line 36 from line 35

38 - 47 Voluntary Gifts to:

Aid to Education .................................

Arizona Wildlife ...................................

Child Abuse Prevention ......................

Domestic Violence Shelter .................

I Didn’t Pay Enough Fund...................

National Guard Relief Fund ................

Neighbors Helping Neighbors.............

Special Olympics ................................

Veterans’ Donations Fund ..................

Political Gift.........................................

48 Voluntary Political Gift

(check only one):

Americans Elect

Democratic

Green

Libertarian

Republican

49 Estimated payment penalty and MSA withdrawal penalty .................................................................................................

50 Check applicable boxes ....

Annualized/Other

Farmer or Fisherman

Form 221 attached

MSA Penalty

51 Total of lines 38 through 47 and 49 ...................................................................................................................................

52 REFUND:

.............................................................

Subtract line 51 from line 37. If less than zero, enter amount owed on line 53

Direct Deposit of Refund: Check box

if your deposit will be ultimately placed in a foreign account; see instructions.

ROUTING NUMBER

ACCOUNT NUMBER

Checking or

Savings

53 AMOUNT OWED:

Add lines 34 and 51. Make check payable to Arizona Department of Revenue; include SSN on payment.

ADOR 10413 (12)