ARIZONA FORM
Resident Partner’s Share of Adjustment
165
2012
to Partnership Income
Schedule K-1
CHECK ONE:
M M D D Y Y Y Y
M M D D Y Y Y Y
For the
calendar year 2012 or
fi scal year beginning
and ending
.
Original
Amended
Partner’s identifying number
Partnership’s employer identifi cation number
Partner’s name, address, and ZIP code
Partnership’s name, address, and ZIP code
Before change
or termination
Partner’s percentage of:
End of year
Profi t sharing ........................................................................
%
%
Loss sharing .........................................................................
%
%
Ownership of capital.............................................................
%
%
Type of partner (individual, trust, etc.):
NOTE: CORPORATE PARTNERS MUST USE FORM 165, SCHEDULE K-1(NR).
00
1
Adjustment of partnership income from federal to Arizona basis - from Form 165, page 1, line 6 ................
1
.
2
Partner’s percentage of profi t or loss (expressed as a decimal) ...................................................................
2
3
Partner’s distributive share of the adjustment of partnership income from federal to
00
Arizona basis - multiply line 1 by line 2 ..........................................................................................................
3
Print
PARTNER’S INSTRUCTIONS
The partnership is required to adjust its income from a federal to Arizona basis. Line 3 of Form 165, Schedule K-1, is the partner’s distributive share of that
adjustment. Report the amount from line 3 on your Arizona tax return according to the instructions below.
Resident Individuals:
If line 3 is a positive number, enter the amount on Form 140, page 2, line B11.
If line 3 is a negative number, enter the amount on Form 140, page 2, line C29.
Part-Year Resident Individuals:
If line 3 is a positive number, enter that portion of line 3 that is allocable to partnership income taxable by Arizona on Form 140PY, page 2, line C23.
If line 3 is a negative number, enter that portion of line 3 that is allocable to partnership income taxable by Arizona on Form 140PY, page 2, line D35.
Resident Estates or Resident Trusts:
If line 3 is a positive number, enter the amount on Form 141AZ, page 2, Schedule B, line B3.
If line 3 is a negative number, enter the amount on Form 141AZ, page 2, Schedule B, line B8.
ADOR 10344 (12)