Arizona Form 140py - Part-Year Resident Personal Income Tax Art-Year Resident Personal Income Tax - 2011 Page 9
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45Form 140PY
If you or your spouse were partially blind as of December
Line A2 - Total Dependents
31, 2011, you must get a statement certified by your eye
Enter the total number of persons listed on line(s) A1. Enter
doctor or registered optometrist that:
the same number on the front of the return in box 10.
1. You cannot see better than 20/200 in your better eye with
Lines A3a and A3b - Persons You Did Not
glasses or contact lenses or
Take as Dependents on Your Federal Return
2. Your field of vision is 20 degrees or less.
If your eye condition is not likely to improve beyond the
On line A3a, enter the following.
conditions listed above, you can get a statement certified by
1. The names of any dependents age 65 or over listed on
your eye doctor or registered optometrist to that effect instead.
line(s) A1 that you cannot take as a dependent on your
You must keep the statement for your records.
federal return.
Line 10 Box - Dependents
2. The name of any stillborn child listed on line(s) A1, if
the stillborn child was named. If the stillborn child was
You must complete Part A, lines A1 through A3b, on page 2 of
not named, enter “stillborn child” on line A3a. Also
your return before you can total your dependent exemptions.
enter the date of birth resulting in the stillbirth.
You may claim only the following as a dependent.
On line A3b, enter the name of any student listed on line(s)
x
A person that qualifies as your dependent on your
A1, that you did not claim as an exemption on your federal
federal return.
return in order to allow that student to claim a federal
NOTE: If you do not claim a dependent exemption for a
education credit on the student’s federal return.
student on your federal return in order to allow the student
Line 11 Box - Qualifying Parents and
to claim a federal education credit on the student’s federal
Grandparents
return, you may still claim the exemption on your Arizona
return.
For more information, see Arizona Individual
A qualifying parent or grandparent may be any one of the
Income Tax Ruling ITR 05-02.
following.
x
A person who is age 65 or over (related to you or not)
x
Your parent or your grandparent, great grandparent,
that does not qualify as your dependent on your federal
great great grandparent, etc.
return, but one of the following applies.
x
If married filing a joint return, your spouse’s parent or
1.
In 2011, you paid more than one-fourth of the cost of
grandparent, great grandparent, great great grandparent,
keeping this person in an Arizona nursing care institution,
etc.
an Arizona residential care institution, or an Arizona
You may claim this exemption if all of the following apply.
assisted living facility. Your cost must be more than $800.
1. The parent or grandparent lived in your principal
2. In 2011, you paid more than $800 for either Arizona
residence for the entire taxable year.
home health care or other medical costs for the person.
2. You paid more than one-half of the support and
x
A stillborn child if the following apply:
maintenance costs of the parent or grandparent during
the taxable year.
1. The stillbirth occurred in Arizona during 2011.
3. The parent or grandparent was 65 years old or older
2. You received a certificate of birth resulting in stillbirth
during 2011.
from the Arizona Department of Health Services.
4. The parent or grandparent required assistance with
3. The child would have otherwise been a member of your
activities of daily living, like getting in and out of bed
household.
or chairs, walking around, going outdoors, using the
Completing Line(s) A1
toilet, bathing, shaving, brushing teeth, combing hair,
dressing, medicating or feeding.
NOTE: If a person who qualifies as your dependent is also
You must complete Part A, lines A4 and A5, on page 2 of
a qualifying parent or grandparent, you may claim that
person as a dependent on line A2, or you may claim that
your return before you can total your exemptions for
qualifying parents and grandparents.
person as a qualifying parent or grandparent on line A5.
You may not claim that same person on both line A2 and
NOTE: If a person who is a qualifying parent or grandparent
line A5. Do not list the same person on line A1 that you
also qualifies as your dependent, you may claim that person as a
listed on line A4.
dependent on line A2, or you may claim that person as a
Enter the following on line(s) A1.
qualifying parent or grandparent on line A5. You may not claim
1. The dependent's name.
If you are claiming an
that same person on both line A2 and line A5. Do not list the
exemption for a stillborn child and the child was not
same person on line A4 that you listed on line A1.
named, enter “stillborn child” in place of a name.
Completing Line(s) A4
2. The dependent's SSN. If you are claiming an exemption
Enter the following on line(s) A4.
for a stillborn child enter the certificate number from
the certificate of birth resulting in stillbirth.
1.
The name of the qualifying parent or grandparent.
2. The SSN of the qualifying parent or grandparent.
3. The dependent's relationship to you.
3. The qualifying parent’s or grandparent’s relationship to
4. The number of months the dependent lived in your
you, or your spouse if filing a joint return.
home during 2011. If you are claiming an exemption
for a stillborn child, enter the date of birth resulting in
4. The number of months the qualifying parent or
grandparent lived in your home during 2011.
the stillbirth.
You may lose the exemption if you do not furnish this
You may lose the exemption if you do not furnish this
information.
information.
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