Arizona Form 120s - Arizona S Corporation Income Tax Return - 2013 Page 3
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1
2
3Name (as shown on page 1)
EIN
Schedule C – Shareholder Information
Prepare a schedule that lists each shareholder’s name, address, taxpayer identification number, and pro rata share of the amount shown on line 1.
label the listing as “Schedule C – Shareholder Information” and attach the schedule immediately after page 3 of Form 120S.
The following declaration must be signed by one or more of the following officers: president, treasurer, or any other principal officer.
under penalties of perjury, I(we), the undersigned officer(s) authorized to sign this return, declare that I(we) have examined this return,
Declaration
including the accompanying schedules and statements, and to the best of my(our) knowledge and belief, it is a true, correct and
complete return, made in good faith, for the taxable year stated pursuant to the income tax laws of the State of Arizona.
Please
OFFICER’S SIgNATuRE
DATE
TITlE
Sign
Here
OFFICER’S SIgNATuRE
DATE
TITlE
PAID PREPARER’S SIgNATuRE
DATE
PAID PREPARER’S PTIN
Paid
Preparer’s
FIRm’S NAmE (OR PAID PREPARER’S NAmE, IF SElF-EmPlOyED)
FIRm’S
EIN OR
SSN
Use
FIRm’S STREET ADDRESS
FIRm’S TElEPHONE NumBER
Only
CITy
STATE
ZIP CODE
Mail to: Arizona Department of Revenue, PO Box 29079, Phoenix, AZ 85038-9079
Print
ADOR 10337 (13)
AZ Form 120S (2013)
Page 3 of 3
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