Arizona Form 140a - Resident Personal Income Tax Return (Short Form) - 2012

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DUALTT-
FOR
ARIZONA FORM
CALENDAR YEAR
2012
140A
Resident Personal Income Tax Return (Short Form)
STOP
If your Arizona taxable income is $50,000 or more, you must use Arizona Form 140.
Reset
Print 140A Return
Calculate
x
Check box 82F if filing under extension
89
82F
Your First Name and Middle Initial
Last Name
Your Social Security No.
Enter
1
your
Spouse’s First Name and Middle Initial (if box 4 or 6 checked)
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)
2
94
City, Town or Post Office
State Zip Code
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
NOTE - Yellow fields are Read-Only.
3
You can not enter data in the yellow fields.
4
Married filing joint return
They calculate as you enter data in the
NAME OF QUALIFYING CHILD OR DEPENDENT
Head of household ......
5
white fields.
6
Married filing separate return. Enter spouse’s name and Social Security No. above.
88
If a field doesn't seem to calculate, continue
7
Single
filling in the white fields and the calculations
Ð Enter the number claimed. Do not put a check mark.
will "catch up".
81
80
8
Age 65 or over (you and/or spouse)
Go to DEPENDENTS: Page 2, Part A
9
Blind (you and/or spouse)
Use GREEN buttons to move around the return.
10
Dependents.
From page 2, line A2 - do not include self or spouse.
11
Qualifying parents and grandparents.
From page 2, line A5.
This box may be blank or may contain a printed barcode of data from your return.
00
12 Federal adjusted gross income ................. 12
I M P O R T A N T - Please Read
00
13 Exempt–Age 65 or over ............................. 13
Line 13 = Box 8 x $2,100
- This form is provided in a fill-in format.
00
14 Exempt–Blind ............................................ 14
Line 14 = Box 9 x $1,500
00
Line 15 = Box 10 x $2,300
15 Exempt–Dependents ................................. 15
- When this form is printed using the PRINT button on the upper right
00
corner of this return, a two dimensional (2D) barcode is generated that
16 Exempt–Qualifying parents/grandparents . 16
Line 16 = Box 11 x $10,000
includes the data entered in the form.
00
17 Total subtractions:
.. 17
Add lines 13 through 16.
00
18 Arizona AGI:
.... 18
Subtract line 17 from line 12
- Using a 2D barcode vastly speeds up processing your return.
00
Select Standard Deduction
19 Standard deduction ................................... 19
- Do NOT handwrite any data on the form other than your signature(s).
00
Select Personal Exemption Filing Status
20 Personal exemptions ................................. 20
00
21 AZ taxable income:
21
Line 18 - lines (19 + 20) .
- Use the PRINT button on this form to print this return.
00
Tax Table
22 Tax from Optional Tax Tables ..................... 22
00
- Use the BLACK ink setting of your printer to print this return. Do not use
23 Family income tax credit
... 23
(instructions p. 8)
the color ink setting.
00
24 Subtract line 23 from line 22 ...................... 24
00
25 Clean Elections Fund Tax Credit for donations made prior to August 2, 2012
.
25
(from worksheet on page 8 of the instructions)
00
26 Balance of tax:
.............................................................
26
Subtract line 25 from line 24. If line 25 is more than line 24, enter zero
00
27 Arizona income tax withheld during 2012 ..........................................................................................................................
27
00
28 2012 Arizona extension payment (Form 204) ....................................................................................................................
28
00
29 Increased Excise Tax Credit
.............................................................................
29
(from worksheet on page 9 of the instructions)
00
30 Property Tax Credit
..............................................................................................................................
30
(from Form 140PTC)
00
31 Total payments/credits:
...............................................................................................................
31
Add lines 27 through 30
00
32 TAX DUE:
..........................
32
If line 26 is larger than line 31, subtract line 31 from line 26, and enter amount of tax due. Skip line 33
00
33 OVERPAYMENT:
.....................
33
If line 31 is larger than line 26, subtract line 26 from line 31, and enter the amount of overpayment
34 - 43 Voluntary Gifts to:
00
00
34
35
Aid to Education .................................
Arizona Wildlife ...................................
00
00
Child Abuse Prevention ......................
36
37
Domestic Violence Shelter .................
00
00
I Didn’t Pay Enough Fund...................
38
39
National Guard Relief Fund ................
00
00
40
41
Neighbors Helping Neighbors.............
Special Olympics ................................
00
00
42
43
Veterans’ Donations Fund ..................
Political Gift.........................................
44 Voluntary Political Gift
1
2
3
4
5
(check only one):
Americans Elect
Democratic
Green
Libertarian
Republican
44
44
44
44
44
00
45 Total voluntary gifts:
........................................................................................................................
45
Add lines 34 through 43
00
46 REFUND:
.............................................................
46
Subtract line 45 from line 33. If less than zero, enter amount owed on line 47
A
A
Direct Deposit of Refund: Check box
if your deposit will be ultimately placed in a foreign account; see instructions.
46
46
ROUTING NUMBER
ACCOUNT NUMBER
C
Checking or
98
S
Savings
00
47 AMOUNT OWED:
...
47
Add lines 32 and 45. Make check payable to Arizona Department of Revenue; include SSN on payment
PLEASE BE SURE TO SIGN THE RETURN ON THE REVERSE SIDE OF THIS PAGE.
ADOR 10414 (12)
1250 v1

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