The Arizona 140PY form is the official Part-Year Resident Personal Income Tax Return used by individuals who have lived in Arizona for part of the tax year. This form allows part-year residents to accurately report their income and calculate their tax obligations based on their residency status. Understanding how to complete this form is essential for ensuring compliance with Arizona tax laws.
The Arizona 140Py form serves as the Part-Year Resident Personal Income Tax Return, specifically designed for individuals who have lived in Arizona for only part of the tax year. This form is crucial for accurately reporting income earned during the period of residency in the state. It requires detailed information about personal exemptions, residency status, and various income sources, including wages, dividends, and other earnings. Taxpayers must also provide information on any deductions and credits applicable to their situation. The form includes sections for calculating Arizona taxable income, which is essential for determining the tax owed or any potential refund. Furthermore, it allows for the reporting of estimated tax payments and other refundable credits. Completing the 140Py form correctly ensures compliance with Arizona tax laws while maximizing any potential benefits available to part-year residents.
NO TAPE.
ARIZONA FORM
Part-Year Resident Personal Income Tax Return
FOR
140PY
CALENDAR YEAR
OR FISCAL YEAR BEGINNING
M
D
Y
AND ENDING
.
2012
82F
Check box 82F if filing under extension
Your First Name and Middle Initial
Last Name
Enter
Your Social Security No.
1
your
Spouse’s First Name and Middle Initial (if box 4 or 6 checked)
Spouse’s Social Security No.
SSN(s)
Current Home Address - number and street, rural route
Apt. No.
Daytime Phone (with area code)
Home Phone (with area code)
2
94
City, Town or Post Office
State
Zip Code
3
4
Married filing joint return
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
5
Head of household
►
NAME OF QUALIFYING CHILD OR DEPENDENT
6
Married filing separate return. Enter spouse’s name and Social Security No. above.
7
Single
page 2; staplecorner.uppertoleft
EXEMPTIONSSTATUSFILING
Enter the number claimed. Do not put a check mark.
88
8
Age 65 or over (you and/or spouse)
9
Blind (you and/or spouse)
10
Dependents. From page 2, line A2 – do not include self or spouse.
81
80
11
Qualifying parents and grandparents from page 2, line A5.
12-13 Residency Status (check one):
12
Part-Year Resident Other than Active Military
13
Part-Year Resident Active Military
14
Federal adjusted gross income (from your federal return)
...............................................................
00
15
Arizona income (from page 2, line B19)
Form
16
Additions to income (from page 2, line C24)
17
Subtractions from income (from page 2, line D36)
after
18
Arizona adjusted gross income: Add lines 15 and 16 then subtract line 17
documents
19
Deductions. Check box and enter amount. See instructions, page 16
19I
ITEMIZED 19S
STANDARD
20
Personal exemptions. See page 16 of the instructions
21
Arizona taxable income: Subtract lines 19 and 20 from line 18.
If less than zero, enter zero
other
22
Compute the tax using Tax Table X or Y
23
Tax from recapture of credits from Arizona Form 301, Part II, line 35
or
24
Subtotal of tax: Add lines 22 and 23
schedules
25
Family income tax credit from worksheet on pages 17 and 18 of the instructions
.............................................................
26
Credits from Arizona Form 301, Part II, line 68, or Forms 310, 321, 322 and 323, if Form 301 is not required
27
Credit type: Enter form number of each credit claimed
..............
AZ
28
Clean Elections Fund Tax Credit for donations made prior to August 2, 2012 (from worksheet on page 20 of the instructions)
and
29
Balance of tax: Subtract lines 25, 26 and 28 from line 24.
If the sum of lines 25, 26 and 28 is more than line 24, enter zero
federal
30
Arizona income tax withheld during 2012
31
Arizona estimated tax payments for 2012
required
32
2012 Arizona extension payment (Form 204)
33
Increased Excise Tax Credit: From worksheet on page 20 of the instructions
34
Other refundable credits: Check the box(es) and enter the amount
341
Form 308-I
342
Form 342
any
35
Total payments/refundable credits: Add lines 30 through 34
Place
36
TAX DUE: If line 29 is larger than line 35, subtract line 35 from line 29, and enter amount of tax due. Skip lines 37, 38 and 39
37
OVERPAYMENT: If line 35 is larger than line 29, subtract line 29 from line 35, and enter amount of overpayment
38
Amount of line 37 to be applied to 2013 estimated tax
TAPE.
39
Balance of overpayment: Subtract line 38 from line 37
40 - 49 Voluntary Gifts to:
Aid to Education
40
Arizona Wildlife
41
NO
.................................
Child Abuse Prevention
42
Domestic Violence Shelter
43
HERE.
I Didn’t Pay Enough Fund
44
National Guard Relief Fund
45
Neighbors Helping Neighbors
46
Special Olympics
47
Veterans’ Donations Fund
48
Political Gift
49
PAYMENT
50
Voluntary Political Gift (check only one):
501 Americans Elect
502
Democratic 503
Green 504 Libertarian
505
Republican
51
Estimated payment penalty and MSA withdrawal penalty
52
....Check applicable boxes 521
Annualized/Other
522
Farmer or Fisherman 523
Form 221 attached 524
MSA Penalty
STAPLE
53
Total of lines 40 through 49 and 51
....................................................................................................................................
54
REFUND: Subtract line 53 from line 39.
If less than zero, enter amount owed on line 55
Direct Deposit of Refund: Check box 54A if your deposit will be ultimately placed in a foreign account; see instructions
54A
ROUTING NUMBER
ACCOUNT NUMBER
C
Checking or
98
S
Savings
55
AMOUNT OWED: Add lines 36 and 53.
Make check payable to Arizona Department of Revenue; include SSN on payment
ADOR 10149 (12)
Your Name (as shown on page 1)
A1
List children and other dependents. Do not list yourself or spouse. If more space is needed,
attach a separate sheet.
NO. OF MONTHS LIVED
FIRST AND LAST NAME
SOCIAL SECURITY NO.
RELATIONSHIP
IN YOUR HOME IN 2012
DependentsA:
b Enter dependents listed above who were not claimed on your federal return due to education credits:
A2
Enter total number of persons listed in A1 here and on the front of this form, box 10
TOTAL
A3
a Enter the names of the dependents listed above who do not qualify as your dependent on your federal return:
PART
A4
List qualifying parents and grandparents. If more space is needed, attach a separate sheet.
You cannot list the same person here and also on line A1. For information on who is a
qualifying parent or grandparent, see page 5 of the instructions.
A5
Enter total number of persons listed in A4 here and on the front of this form, box 11
B6
Dates of Arizona residency: From
Y Y
to
M M
D D
Y Y Y
2012 FEDERAL
2012 ARIZONA
Income
List other state(s) of residency:
Amount from Federal Return
Amount Only
B8
............................................................................................................................................Interest
B7
Wages, salaries, tips, etc
Total
B9
Dividends
of
B10
Arizona income tax refunds
B11
Alimony received
Percent
B13
.....................................................................................Gains (or losses) from federal Schedule D
B12
Business income (or loss) from federal Schedule C
Arizona
B14
Rents, royalties, partnerships, estates, trusts, small business corporations from federal Schedule E.
B15
Other income reported on your federal return
B:
B16
Total income: Add lines B7 through B15
B17
Federal adjustments. Attach your own schedule
B18
Federal adjusted gross income: Subtract line B17 from line B16 in the FEDERAL column
B19
Arizona income: Subtract line B17 from line B16 in the ARIZONA column. Enter here and on the front of this form, line 15
B20
Arizona percentage: Divide line B19 by line B18, and enter the result (not over 100%)
%
PARTC: Additions
C21
I.R.C. §179 expense in excess of allowable amount. Also see the instructions for line D34
C22
Total depreciation included in Arizona gross income
C23
Other additions to income: See instructions and attach your own schedule
C24
Total: Add lines C21 through C23.
Enter here and on the front of this form on line 16
..................................................................
D25
Exemption: Age 65 or over. Multiply the number in box 8, page 1, by $2,100
D27
.........................................Exemption: Dependents. Multiply the number in box 10, page 1, by $2,300
D26
Exemption: Blind. Multiply the number in box 9, page 1, by $1,500
from
D28
Exemption: Qualifying parents and grandparents. Multiply the number in box 11, page 1, by $10,000 .
Subtractions
D29
Total exemptions: Add lines D25 through D28
D30
Multiply line D29 by the percentage on line B20, and enter the result
D31
Interest on U.S. obligations such as U.S. savings bonds and treasury bills included in the ARIZONA column
D32
Arizona state lottery winnings included on line B15 in the ARIZONA column (up to $5,000 only)
D:
D33
U.S. Social Security or Railroad Retirement Act benefits included in your ARIZONA income
D34
Adjustment for I.R.C. §179 expense not allowed
D35
Other subtractions from income: See instructions and attach your own schedule
D36
Total: Add lines D30 through D35.
Enter here and on the front of this form, line 17
E37 Last name(s) used in prior years – if different from name(s) used in current year:
HERE
I have read this return and any attachments with it. Under penalties of perjury, I declare that to the best of my knowledge and belief, they are
true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
SIGN
YOUR SIGNATURE
DATE
OCCUPATION
SPOUSE’S SIGNATURE
SPOUSE’S OCCUPATION
PLEASE
PAID PREPARER’S SIGNATURE
FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED)
(
)
PAID PREPARER’S TIN
PAID PREPARER’S ADDRESS
PAID PREPARER’S PHONE NO.
If you are sending a payment with this return, mail to Arizona Department of Revenue, PO Box 52016, Phoenix, AZ, 85072-2016.
If you are expecting a refund or owe no tax, or owe tax but are not sending a payment, mail to Arizona Department of Revenue, PO Box 52138, Phoenix, AZ, 85072-2138.
AZ Form 140PY (2012)
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