Arizona Form 140py - Part-Year Resident Personal Income Tax Return - 2012

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ARIZONA FORM

Part-Year Resident Personal Income Tax Return

FOR

140PY

CALENDAR YEAR

M M D D Y Y Y Y

2012

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.

12-13 Residency Status

: 12

Part-Year Resident Other than Active Military

Part-Year Resident Active Military

(check one)

14 Federal adjusted gross income

............................................................... 14

(from your federal return)

15 Arizona income

.................................................................................................................................. 15

(from page 2, line B19)

16 Additions to income

........................................................................................................................... 16

(from page 2, line C24)

17 Subtractions from income

.................................................................................................................. 17

(from page 2, line D36)

18 Arizona adjusted gross income:

.......................................................................... 18

Add lines 15 and 16 then subtract line 17

19 Deductions. Check box and enter amount.

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

ITEMIZED

STANDARD 19

See instructions, page 16

20 Personal exemptions.

............................................................................................................ 20

See page 16 of the instructions

21 Arizona taxable income:

....................................................... 21

Subtract lines 19 and 20 from line 18. If less than zero, enter zero

22 Compute the tax using Tax Table X or Y ............................................................................................................................. 22

23 Tax from recapture of credits from Arizona Form 301, Part II, line 35 ................................................................................ 23

24 Subtotal of tax:

...................................................................................................................................... 24

Add lines 22 and 23

25 Family income tax credit from worksheet on pages 17 and 18 of the instructions ............................................................. 25

26 Credits from Arizona Form 301, Part II, line 68, or Forms 310, 321, 322 and 323, if Form 301 is not required ................. 26

27 Credit type:

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

Enter form number of each credit claimed

28 Clean Elections Fund Tax Credit for donations made prior to August 2, 2012 (f

)

rom worksheet on page 20 of the instructions

29 Balance of tax:

............ 29

Subtract lines 25, 26 and 28 from line 24. If the sum of lines 25, 26 and 28 is more than line 24, enter zero

30 Arizona income tax withheld during 2012 ........................................................................................................................... 30

31 Arizona estimated tax payments for 2012 .......................................................................................................................... 31

32 2012 Arizona extension payment (Form 204) ..................................................................................................................... 32

33 Increased Excise Tax Credit:

........................................................................... 33

From worksheet on page 20 of the instructions

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

Form 308-I

Form 342 34

35 Total payments/refundable credits:

............................................................................................. 35

Add lines 30 through 34

36 TAX DUE:

........... 36

If line 29 is larger than line 35, subtract line 35 from line 29, and enter amount of tax due. Skip lines 37, 38 and 39

37 OVERPAYMENT:

........................... 37

If line 35 is larger than line 29, subtract line 29 from line 35, and enter amount of overpayment

38 Amount of line 37 to be applied to 2013 estimated tax ....................................................................................................... 38

39 Balance of overpayment:

........................................................................................................... 39

Subtract line 38 from line 37

40 - 49 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.........................................

50 Voluntary Political Gift

(check only one):

Americans Elect

Democratic

Green

Libertarian

Republican

51 Estimated payment penalty and MSA withdrawal penalty .................................................................................................. 51

52 Check applicable boxes ....

Annualized/Other

Farmer or Fisherman

Form 221 attached

MSA Penalty

53 Total of lines 40 through 49 and 51 .................................................................................................................................... 53

54 REFUND:

.............................................................. 54

Subtract line 53 from line 39. If less than zero, enter amount owed on line 55

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

55 AMOUNT OWED:

........ 55

Add lines 36 and 53.