Arizona Tax Credit Donation Form With Contributor Choice

Arizona Tax Credit Donation Form

Arizona’s tax law (ARS 43-1089.01) allows a single individual, head of household or married filing separate taxpayer

to take a credit up to $200.00. A married couple filing jointly can take a credit up to $400.00.

The Tax Credit is available to all Arizona taxpayers (having a child that attends Espiritu Schools is not a

requirement). This is a tax credit, if you pay AZ state taxes, the tax credit will save you dollar for dollar up to the

limit, $400.00 for married couples filing jointly or $200.00 for individuals. A tax Credit is subtracted from the

amount of taxes you owe and is refundable up to the amount of your tax liability. For more information you can

visit the AZ department of Revenue at

Donor Name: _______________________________________________________

(Please print clearly)

Address: _____________________________________________________________

_____________________________________________________________

Total Amount Contributed: $___________ (Donate $20, $50, $100, $200, $300, $400)

Check __________Credit Card __________ Cash_____________

Where I want my donation to go (Circle Your Choices):

1. Pick a school:

Reyes Maria Ruiz Leadership Academy (K-6),

AIM Higher (7),

NFL YET (7-12)

2. Pick a Program:

Band,

Sports, Tutoring, Field Trips, Technology, Clubs (please list) ____________

Other _________________________

3.

I don’t have a preference, please use my donation where it is most needed.

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Make a photo copy of check or credit card receipt here.

Authorized Signature: ______________________________ Date: _________________________

A copy of this form is your official receipt, verifying that you have contributed to an eligible activity.

Espiritu Tax ID Number: 86-0778361

AZ Tax Form 322