Arizona Form 140nr - Nonresident Personal Income Tax Return - 2011 Page 2

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ARIZONA FORM

FOR

Nonresident Personal Income Tax Return

140NR

CALENDAR YEAR

Calculate

2011

OR FISCAL YEAR BEGINNING

AND ENDING

Reset

Check box 82F if filing under extension

82F

Your First Name and Initial

Last Name

Your Social Security No.

You must

enter your

Spouse’s First Name and 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

NOTE: Yellow fields are Read-Only.

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

You can not enter data in the yellow fields.

Married filing joint return

They calculate as you enter data in the white

NAME OF QUALIFYING CHILD OR DEPENDENT

Head of household .......................... ►

fields.

Married filing separate return. Enter spouse’s name and Social Security No. above.

If the field doesn't seem to calculate, continue

Single

filling in the white fields and the calculations

Enter the number claimed. Do not put a check mark.

will "catch up".

Age 65 or over (you and/or spouse)

Blind (you and/or spouse)

Use GREEN buttons to move around the form.

Dependents

Dependents. From page 2, line A2 – Do not include self or spouse.

11-13 Residency Status (check one): 11

Nonresident 12

Nonresident Active Military 13

Composite Return

This box may be blank or may contain a printed barcode of data from your return.

14 Federal AGI ........

I M P O R T A N T - P l e a s e R e a d

Income

15 Arizona income

........ 15

(from page 2, line B16)

Additions

- This form is provided in a fill-in-format.

16 Additions to income

. 16

(from page 2, line C21)

Subtractions

17 Subtractions

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

(from page 2, line D32)

- When this form is printed using the PRINT button on the upper right

Lines (15 + 16) − line 17

18 Arizona AGI:

........ 18

corner of this return, a two dimensional (2D) barcode is generated that

ITEMIZED

STANDARD

includes the data entered in this form.

Select Personal Exemptions

20 Personal exemptions ................................ 20

- Using a 2D barcode vastly speeds up processing your return.

Line 18 − lines (19 + 20)

21 AZ taxable income:

X&Y Tax Table

22 Compute the tax: Use Tax Table X or Y ... 22

- Do NOT handwrite any data on the form other than your signature(s).

23 Tax from recapture of credits .................... 23

- Use the PRINT button on this form to print your return.

24 Subtotal of tax:

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

Add lines 22 and 23

25 - 26

YOURSELF

SPOUSE 26

- Use the BLACK ink setting of your printer to print this return. Do not use

the color ink setting.

27 Reduced tax:

... 27

Subtract line 26 from line 24

28 Credits

........ 28

(from Forms 301, 321, 322, 323)

29 Credit type:

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

Enter form number of each credit claimed

30 Clean Elections Fund Tax Credit.

....................................................................... 30

From worksheet on page 15 of the instructions

31 Balance of income tax:

.............. 31

Subtract lines 28 and 30 from line 27. If the sum of lines 28 and 30 is more than line 27, enter zero

Use Tax Worksheet

32 Unpaid Arizona use tax

........................................................................................... 32

(from worksheet on page 16 of instructions)

33 Balance of tax:

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

Add lines 31 and 32

34 Arizona income tax withheld during 2011 ............................................................................................................................. 34

No Withholding? Click this button

35 Arizona estimated tax payments for 2011 ............................................................................................................................. 35

36 2011 Arizona extension payment (Form 204) ....................................................................................................................... 36

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

Form 308-I

Form 342

38 Total payments/refundable credits:

............................................................................................... 38

Add lines 34 through 37

39 TAX DUE:

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

If line 33 is larger than line 38, subtract line 38 from line 33, and enter amount of tax due. Skip lines 40, 41 and 42

40 OVERPAYMENT:

............................. 40

If line 38 is larger than line 33, subtract line 33 from line 38, and enter amount of overpayment

41 Amount of line 40 to be applied to 2012 estimated tax ......................................................................................................... 41

42 Balance of overpayment:

............................................................................................................. 42

Subtract line 41 from line 40

Aid to Education

43 - 53 Voluntary Gifts to ...........................

Arizona Wildlife .............

(entire refund only) .........

Domestic Violence

Citizens Clean Elections ..

Child Abuse Prevention ...

Shelter .........................

Neighbors Helping

I Didn’t Pay Enough Fund

National Guard Relief Fund

Neighbors .....................

Special Olympics ...........

Veterans’ Donations Fund

Political Gift ..................

54 Check only one if making a political gift ................

Democratic

Green

Libertarian

Republican

55 Estimated payment penalty and MSA withdrawal penalty .................................................................................................... 55

56 Check applicable boxes .....

Annualized/Other

Farmer or Fisherman

Form 221 attached

MSA Penalty

57 Total of lines 43 through 53 and 55 ....................................................................................................................................... 57

58 REFUND:

................................................................ 58

Subtract line 57 from line 42. If less than zero, enter amount owed on line 59

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

59 AMOUNT OWED:

............ 59

Add lines 39 and 57. Make check payable to Arizona Department of Revenue; include SSN on payment