Arizona Form 140ez - Resident Personal Income Tax Return (Ez Form) - 2012

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FOR

ARIZONA FORM

CALENDAR YEAR

140EZ

2012

Resident Personal Income Tax Return (EZ Form)

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 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.

STOP

You must use Arizona Form 140 if:

• Your Arizona taxable income on line 8 is $50,000 or more.

• You are claiming estimated payments.

• You are taking a subtraction for:

– active duty military pay

– wages earned on Indian reservation(s)

FILING STATUS: Check one box.

Married filing joint return

Single

6 Federal adjusted gross income from your federal return ...........................................................................

7 Standard deduction and personal exemption: If you checked filing status box 4, enter $13,865; if you

checked filing status box 5, enter $6,933 ...................................................................................................

8 Arizona taxable income: Subtract line 7 from line 6. If less than zero, enter zero ...................................

9 Amount of tax from Optional Tax Tables ....................................................................................................

10 Family income tax credit from worksheet on page 5 of instructions........................................................... 10

11 Clean Elections Fund Tax Credit for donations made prior to August 2, 2012, from worksheet

on page 5 of the instructions ...................................................................................................................... 11

12 Balance of tax: Subtract lines 10 and 11 from line 9. If the sum of lines 10 and 11 is more

than line 9, enter zero ................................................................................................................................ 12

13 Arizona income tax withheld during 2012 .................................................................................................. 13

14 2012 Arizona extension payment (Form 204) ............................................................................................ 14

15 Increased Excise Tax Credit from worksheet on page 6 of the instructions ............................................... 15

16 Total payments/credits: Add lines 13 through 15 ................................................................................... 16

17 TAX DUE / AMOUNT OWED: If line 12 is more than line 16, subtract line 16 from line 12. Skip line 18.

Make check payable to Arizona Department of Revenue; include SSN on payment .............................. 17

18 REFUND / OVERPAYMENT: If line 16 is more than line 12, subtract line 12 from line 16 ....................... 18

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

19 Last name(s) used in prior years - if different from name(s) used in current year

PLEASE SIGN HERE

I have read this return and any attachments with it. Under penalties of perjury, I declare that to the best of my knowledge and belief, they are

true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

YOUR SIGNATURE

DATE

OCCUPATION

SPOUSE’S SIGNATURE

DATE

SPOUSE’S OCCUPATION

PAID PREPARER’S SIGNATURE

DATE

FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED)

(

)

PAID PREPARER’S TIN

PAID PREPARER’S ADDRESS

PAID PREPARER’S PHONE NO.

If you are sending a payment with this return, mail to Arizona Department of Revenue, PO Box 52016, Phoenix, AZ, 85072-2016.

If you are expecting a refund or owe no tax, or owe tax but are not sending a payment, mail to Arizona Department of Revenue, PO Box 52138, Phoenix, AZ, 85072-2138.

ADOR 10534 (12)