ARIZONA FORM |
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Part-Year Resident Personal Income Tax Return |
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FOR |
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CALENDAR YEAR |
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OR FISCAL YEAR BEGINNING |
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D |
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D |
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Y |
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AND ENDING |
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D |
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2012 |
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82F |
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Check box 82F if filing under extension |
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Your First Name and Middle Initial |
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Last Name |
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Enter |
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Your Social Security No. |
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1 |
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your |
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Spouse’s First Name and Middle Initial (if box 4 or 6 checked) |
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Last Name |
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Spouse’s Social Security No. |
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1 |
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SSN(s) |
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Current Home Address - number and street, rural route |
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Apt. No. |
Daytime Phone (with area code) |
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Home Phone (with area code) |
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2 |
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City, Town or Post Office |
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Zip Code |
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4 |
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Married filing joint return |
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REVENUE USE ONLY. DO NOT MARK IN THIS AREA. |
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5 |
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Head of household |
► |
NAME OF QUALIFYING CHILD OR DEPENDENT |
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6 |
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Married filing separate return. Enter spouse’s name and Social Security No. above. |
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7 |
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Single |
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page 2; staplecorner.uppertoleft |
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EXEMPTIONSSTATUSFILING |
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Enter the number claimed. Do not put a check mark. |
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88 |
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8 |
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Age 65 or over (you and/or spouse) |
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9 |
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Blind (you and/or spouse) |
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10 |
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Dependents. From page 2, line A2 – do not include self or spouse. |
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81 |
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80 |
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11 |
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Qualifying parents and grandparents from page 2, line A5. |
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12-13 Residency Status (check one): |
12 |
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Part-Year Resident Other than Active Military |
13 |
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Part-Year Resident Active Military |
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140PY |
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14 |
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Federal adjusted gross income (from your federal return) |
............................................................... |
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00 |
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15 |
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Arizona income (from page 2, line B19) |
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15 |
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00 |
Form |
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16 |
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Additions to income (from page 2, line C24) |
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16 |
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00 |
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17 |
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Subtractions from income (from page 2, line D36) |
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17 |
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00 |
after |
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18 |
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Arizona adjusted gross income: Add lines 15 and 16 then subtract line 17 |
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18 |
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00 |
documents |
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19 |
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Deductions. Check box and enter amount. See instructions, page 16 |
19I |
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ITEMIZED 19S |
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STANDARD |
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19 |
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00 |
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20 |
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Personal exemptions. See page 16 of the instructions |
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20 |
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00 |
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21 |
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Arizona taxable income: Subtract lines 19 and 20 from line 18. |
If less than zero, enter zero |
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21 |
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00 |
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00 |
other |
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22 |
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Compute the tax using Tax Table X or Y |
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22 |
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23 |
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Tax from recapture of credits from Arizona Form 301, Part II, line 35 |
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23 |
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00 |
or |
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24 |
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Subtotal of tax: Add lines 22 and 23 |
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24 |
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00 |
schedules |
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25 |
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Family income tax credit from worksheet on pages 17 and 18 of the instructions |
............................................................. |
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25 |
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00 |
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26 |
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Credits from Arizona Form 301, Part II, line 68, or Forms 310, 321, 322 and 323, if Form 301 is not required |
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26 |
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00 |
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27 |
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Credit type: Enter form number of each credit claimed |
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27 |
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3 |
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3 |
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3 |
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3 |
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.............. |
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AZ |
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28 |
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Clean Elections Fund Tax Credit for donations made prior to August 2, 2012 (from worksheet on page 20 of the instructions) |
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28 |
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00 |
and |
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29 |
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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 |
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29 |
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00 |
federal |
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30 |
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Arizona income tax withheld during 2012 |
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30 |
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00 |
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31 |
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Arizona estimated tax payments for 2012 |
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31 |
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00 |
required |
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32 |
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2012 Arizona extension payment (Form 204) |
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32 |
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00 |
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33 |
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Increased Excise Tax Credit: From worksheet on page 20 of the instructions |
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33 |
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00 |
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34 |
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Other refundable credits: Check the box(es) and enter the amount |
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341 |
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Form 308-I |
342 |
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Form 342 |
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34 |
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00 |
any |
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35 |
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Total payments/refundable credits: Add lines 30 through 34 |
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35 |
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00 |
Place |
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36 |
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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 |
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36 |
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00 |
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37 |
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OVERPAYMENT: If line 35 is larger than line 29, subtract line 29 from line 35, and enter amount of overpayment |
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37 |
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00 |
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38 |
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Amount of line 37 to be applied to 2013 estimated tax |
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38 |
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00 |
TAPE. |
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39 |
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Balance of overpayment: Subtract line 38 from line 37 |
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39 |
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00 |
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40 - 49 Voluntary Gifts to: |
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Aid to Education |
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40 |
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00 |
Arizona Wildlife |
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41 |
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00 |
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NO |
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................................. |
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Child Abuse Prevention |
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42 |
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00 |
Domestic Violence Shelter |
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43 |
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00 |
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HERE. |
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I Didn’t Pay Enough Fund |
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44 |
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00 |
National Guard Relief Fund |
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45 |
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00 |
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Neighbors Helping Neighbors |
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46 |
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00 |
Special Olympics |
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47 |
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00 |
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Veterans’ Donations Fund |
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48 |
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00 |
Political Gift |
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49 |
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00 |
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PAYMENT |
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50 |
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Voluntary Political Gift (check only one): |
501 Americans Elect |
502 |
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Democratic 503 |
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Green 504 Libertarian |
505 |
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Republican |
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51 |
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Estimated payment penalty and MSA withdrawal penalty |
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51 |
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00 |
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52 |
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....Check applicable boxes 521 |
Annualized/Other |
522 |
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Farmer or Fisherman 523 |
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Form 221 attached 524 |
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MSA Penalty |
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STAPLE |
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53 |
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Total of lines 40 through 49 and 51 |
.................................................................................................................................... |
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53 |
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00 |
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54 |
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REFUND: Subtract line 53 from line 39. |
If less than zero, enter amount owed on line 55 |
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54 |
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00 |
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Direct Deposit of Refund: Check box 54A if your deposit will be ultimately placed in a foreign account; see instructions |
54A |
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ROUTING NUMBER |
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ACCOUNT NUMBER |
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C |
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Checking or |
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98 |
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S |
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Savings |
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55 |
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AMOUNT OWED: Add lines 36 and 53. |
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Make check payable to Arizona Department of Revenue; include SSN on payment |
55 |
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00 |