Form 140nr - Nonresident Personal Income Tax - 2013

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FOR
Print
CALENDAR YEAR
Arizona Form 140NR
Nonresident Personal Income Tax Return
2013
Calculate
. 66
OR FISCAL YEAR BEGINNING
AND ENDING
Reset
Check box 82F if filing under extension
x
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)
2
94
City, Town or Post Office
State
ZIP Code
Last Names Used in Prior Year(s)
3
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
4
Married filing joint return
NOTE:
Yellow fields are
88
Read-Only.
5
Head of household –
Enter name of qualifying child or dependent on next line:
You can not enter data in the
6
Married filing separate return. Enter spouse’s name and Social Security No. above.
yellow fields.
They calculate as
7
Single
you enter data in the white
fields.
Enter the number claimed. Do not put a check mark.
80 RCVD
81
PM
8
Age 65 or over (you and/or spouse)
If the field doesn't seem to
Dependents
9
Blind (you and/or spouse)
Use GREEN buttons to move around the for
calculate, continue filling in the
10
Dependents. From page 2, line A2 – Do not include self or spouse.
white fields and the calculations
will "catch up".
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
.
00
I
M
P
O
R
T
A
N
T
-
P l e a s e
R e a d
14 Federal AGI .... 14
Income
00
15 Arizona income
........... 15
(from page 2, line B16)
- This form is provided in a fill-in-format.
Additions
00
16 Additions to income
.... 16
(from page 2, line C21)
- When this form is printed using the PRINT button on the
Subtractions
00
upper right corner of this return, a two dimensional (2D)
17 Subtotal: Add lines 15 and 16 ..................... 17
barcode is generated that includes the data entered in this
00
18 Subtractions from income ............................ 18
form.
00
19 AZ Gain/Loss .
A
19
- Using a 2D barcode vastly speeds up processing your return.
00
Net long-term capital gain subtraction ......... 19
- Do NOT handwrite any data on the form other than your
00
20 Arizona AGI:
............. 20
Line 17 - (lines 18 + 19)
signature(s).
I
S
00
21
ITEMIZED
STANDARD ....... 21
21
21
- Use the PRINT button on this form to print your return.
00
22 Personal exemptions ................................... 22
Select Personal Exemptions
- Use the BLACK ink setting of your printer to print this
00
23 AZ taxable income:
.... 23
Line 20 - (lines 21 + 22)
return.
Do not use the color ink setting.
X&Y Tax Table
00
24 Compute the tax using Tax Table X or Y ...... 24
00
25 Tax from recapture of credits from Arizona Form 301, Part II, line 36 ............................................................................ 25
00
26 Subtotal of tax:
.................................................................................................................................. 26
Add lines 24 and 25
00
27 Credits from Arizona Form 301, Part II, line 69, or Forms 321, 322 and 323 if Form 301 is not required ...................... 27
................. 28
28 Credit type:
Enter form number of each credit claimed
00
29 Balance of tax:
.......................................................... 29
Subtract line 27 from line 26. If line 27 is more than line 26, enter zero
00
30 Arizona income tax withheld during 2013 ....................................................................................................................... 30
00
31 Arizona estimated tax payments for 2013 ...................................................................................................................... 31
No Withholding? Click this button
00
32 2013 Arizona extension payment (Form 204) ................................................................................................................. 32
00
33 Other refundable credits:
1
308-I
2
342
3
349
4
350 33
Check the box(es); enter the amount ...................
33
33
33
33
00
34 Total payments/refundable credits:
......................................................................................... 34
Add lines 30 through 33
00
35 TAX DUE:
....... 35
If line 29 is larger than line 34, subtract line 34 from line 29, and enter amount of tax due. Skip lines 36, 37 and 38
00
36 OVERPAYMENT:
....................... 36
If line 34 is larger than line 29, subtract line 29 from line 34, and enter amount of overpayment
00
37 Amount of line 36 to be applied to 2014 estimated tax ................................................................................................... 37
00
38 Balance of overpayment:
....................................................................................................... 38
Subtract line 37 from line 36
00
00
39 - 48 Voluntary Gifts to:
39
40
Solutions Team Assigned to Schools ......
Arizona Wildlife .........
00
00
00
41
Child Abuse Prevention .......
43
42
Political Gift...............
Domestic Violence Shelter .....................
00
00
00
44
National Guard Relief Fund .
45
46
Neighbors Helping Neighbors.................
Special Olympics ......
00
00
47
Veterans’ Donations Fund ...
48
I Didn’t Pay Enough Fund.......................
49 Voluntary Political gift
(check only one):
1
2
3
4
5
Americans Elect
Democratic
Green
Libertarian
Republican
49
49
49
49
49
00
50 Estimated payment penalty; MSA penalty; and AZ Long-Term Health Care Saving Account (AZLTHSA) penalty ........ 50
51
1
2
3
4
5
Annualized/Other
Farmer or Fisherman
Form 221 attached
MSA Penalty
AZLTHSA Penalty
51
51
51
51
51
00
52 Total of lines 39 through 48 and 50 ................................................................................................................................ 52
00
53 REFUND:
.......................................................... 53
Subtract line 52 from line 38. If less than zero, enter amount owed on line 54
A
A
Direct Deposit of Refund: Check box
if your deposit will be ultimately placed in a foreign account; see instructions.
53
53
ROUTING NUMBER
ACCOUNT NUMBER
C
Checking or
98
S
Savings
00
54 AMOUNT OWED:
54
Add lines 35 and 52. Make check payable to Arizona Department of Revenue; include SSN on payment.
ADOR 10177 (13)
1250 v1

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