Arizona Form 140 - Resident Personal Income Tax Return - 2011 Page 8

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ARIZONA FORM

Credit for Contributions to Charities

321

2011

That Provide Assistance to the Working Poor

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 joint return)

Spouse’s Social Security No.

000000000

Are you claiming itemized deductions on your 2011 Arizona income tax return? .......

Yes

If the answer to question 1 is “Yes”, continue to line 2a.

Return to Credit 301

If “No”, STOP. You cannot claim a current year credit or carryover credit.

Current Year’s Credit

Qualifying charity to which you made cash contributions:

(a)

(b)

(c)

Location of Qualifying Charity

Name of Qualifying Charity

(City, State)

Cash Amount

.00

(If you made cash contributions to more than three qualifying charities, attach a separate schedule.)

2d Total: Add the amounts in column (c) of lines 2a, 2b, and 2c. Also, add any amount included on

a separate schedule ....................................................................................................................................

Single taxpayers or heads of household, enter $200. Married taxpayers, enter $400 ...............................

Current year’s credit: Enter the smaller of line 2d or line 3. If you are married filing a separate

return, enter one-half (½) of the smaller of line 2d or line 3.........................................................................

Available Credit Carryover

(a)

(b)

(c)

(d)

Taxable Year

from which you are

Original

Amount