Arizona Form 140ptc - Property Tax Refund (Credit) Claim - 2012
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Property Tax Refund (Credit) Claim
Reset
ARIZONA FORM
CALENDAR YEAR
140PTC
2012
You must file this form, or Form 204, by April 15, 2013.
Print Return
Check box 82F if filing under extension
82F
View 140PTC Instructions
Check box 95 if amended for year 2012
95
Your First Name and Middle Initial
Last Name
Your Social Security No.
Enter
1
your
If a joint claim, Spouse’s First Name and Middle Initial
Last Name
Spouse’s Social Security No.
SSN(s).
1
Current Home Address - number and street, rural route
Apt. No.
Daytime Phone (with area code)
Home Phone (with area code)
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94
City, Town or Post Office
State Zip Code
Your Date of Birth
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
-As a service to you, this form, along with other forms available
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79
on our website, are provided in a fill-in format. Just type in your
data prior to printing the form.
QUALIFICATIONS FOR CREDIT (Check the boxes that apply):
-When this form is printed, a two dimensional (2D) barcode is
generated that includes the data entered on the form. Using a
4 On December 31, 2012, were you renting or did you own?
Rent Own
2D barcode vastly speeds up processing your form.
If you own a mobile home but rent the space, check “Rent” .......
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88
-Do NOT handwrite any other data on the form other than your
5 Were you an Arizona resident for all of 2012? If “No”, STOP.
Yes
No
signature.
You do not qualify........................................................................
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-Use the PRINT button at the top of the form to print the form
6 Did you pay property taxes on your home, pay rent, or pay a
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80
once filled.
combination of both in 2012? See instructions for qualifications.
-A high quality printer is necessary to print usable copies of the
If “No”, STOP. You do not qualify ...............................................
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forms. Any laser, ink-jet, or bubble-jet printer in good working
7 Is this the only Property Tax Refund being claimed in your
order should be fine.
household? If “No”, STOP. You do not qualify ..........................
7
-Use the BLACK ink setting of your printer to print the form.
8 Were you age 65 or older in 2012? Enter your birth date in
-Do NOT use the color setting.
box 79 above ..............................................................................
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9 Did you receive Title 16, SSI payments in 2012? If “Yes”,
Use GREEN buttons to move around the
attach proof. If you answered “No” to both 8 and 9, STOP.
return.
You do not qualify. .......................................................................
9
Go to Income: Page 2 Part I
INCOME
This box may be blank or contain printed barcode of data from your return.
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10 Income
.. 10
from page 2, Part I, line J, col. 4
YELLOW fields are Read-Only. You can not enter data in
CREDIT
yellow fields.
11a If you lived alone,
If you lived alone, check Box 11a and
enter credit from
…
select income (Line 10) from list
......11a
Schedule I, and check the box
These fields are calculated as you fill in the form.
11b If you didn’t live alone,
If you didn't live alone, check Box 11b and
enter credit from
…
select income (Line 10) from list
00
.....11b
11
Schedule II, and check the box
12 If owned your property,
enter property
00
. Attach proof ... 12
taxes paid during 2012
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13 If you rented,
... 13
enter tax from Form 201
00
14 2012 property taxes paid:
14
lines 12 + 13
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15 Tax Credit:
.. 15
the smaller of line 11 or 14
16 If you have been claimed as a dependent on anyone else’s tax return, complete the following:
Name Of Taxpayer Who Claimed You
Social Security No.
Address:
If you are not claimed as a dependent on anyone else’s tax return, turn the form over and complete Part II.
If someone else claims you as a dependent, skip lines 17 and 18, and complete line 19.
Go to Page 2 Part II
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17 Credit for increased excise taxes from Form 140PTC, page 2, Part II, line 6 ............................................. 17
18 Enter the number from page 2, Part II, line 2, here ...........................................................................18
19 Total Credit: Add lines 15 and 17, and enter the total. See page 5 of the instructions if you have to file
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Arizona Form 140 or Form 140A .................................................................................................................... 19
…
A
A
Direct Deposit of Refund: Check box
if your deposit will be ultimately placed in a foreign account; see instructions ......
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19
…
ROUTING NUMBER
ACCOUNT NUMBER
C
Checking or
…
98
S
Savings
If this is your first claim for 2012, STOP HERE AND GO TO THE SIGNATURE BOX ON PAGE 2. If
this is an amended claim, complete lines 20 through 22, and check the box at the top of the form.
AMENDED
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20 Enter the amount from line 5 of the worksheet on page 6 of the instructions ................................................ 20
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21 Additional refund: If line 19 is larger than line 20, subtract line 20 from line 19 ............................................ 21
22 Amount to pay: If line 19 is less than line 20, subtract line 19 from line 20. Make check payable to
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Arizona Department of Revenue; include SSN on payment; attach payment where indicated at left ......... 22
Continued on page 2 Î
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ADOR 10567 (12)
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