Arizona Form 140 - Resident Personal Income Tax Return - 2011 Page 11
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19ARIZONA FORM
Credit for Donations to
340
2011
the Military Family Relief Fund
Return to Credit 301
For the calendar year 2011, or
fiscal year beginning
and ending
.
Attach to your return.
Your Name as shown on Form 140, 140NR, 140PY or 140X
Your Social Security No.
000000000
Spouse’s Name as shown on Form 140, 140NR, 140PY or 140X (if a joint return)
Spouse’s Social Security No.
000000000
YES NO
1
Did you receive a receipt from the Arizona Department of Veterans’
Services that indicates that your contribution qualifies for this credit? ....
1
If you answered “No,” STOP! You do not qualify for this credit.
2
Total qualified donations made to the Military Family Relief Fund
during 2011 ..............................................................................................
2
00
3
Single taxpayers or heads of household, enter $200 here. Married
taxpayers enter $400 here .......................................................................
3
00
4
Current year’s credit before tax: Enter the smaller of line 2 or line 3.
If you are married filing a separate return, enter one-half (½) of
the smaller of line 2 or line 3. Also enter this amount on Form 301,
Part I, line 24 ...........................................................................................
4
00
Return to Credit 301
ADOR 10395 (11)
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