Before you file your 2014 Arizona state tax
return, check what you could be redirecting
to a needy Catholic school at no cost to you!
Take the credit today!
DO NOT STAPLE ANY ITEMS TO THE RETURN.
FORM 140
Arizona Form
1
1
2
FOR CALENDAR YEAR
Resident Personal Income Tax Return
140
Check box 82F
if filing under extension
82F
Your First Name and Middle Initial
Last Name
Spouse’s First Name and Middle Initial (if box 4 or 6 checked)
2014
M M D D 2 0 1 4 AND ENDING M M D D 2 0 Y Y .
OR FISCAL YEAR BEGINNING
Last Name
Current Home Address - number and street, rural route
Apt. No.
66F
Your Social Security Number
Enter
your
SSN(s).
Spouse’s Social Security No.
Daytime Phone (with area code)
94
City, Town or Post Office
State
EXEMPTIONS FILING STATUS
3 shown on page 1)
Your Name (as


4
5
ZIP Code
Last Names Used in Last Four Prior Year(s) (if different)
Your Social Security Number
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
Married filing joint return
Head of household: Enter name of qualifying child or dependent on next line:
88
37 Enter the amount from page 1, line 36 ........................................................................................................................... 37
LINE 51
separate in
return:
spouse’s.......................................................................................................
name and Social Security Number above.
 Married
38 Age 65 or 6over:
Multiplyfiling
the number
box 8Enter
by $2,100
38
Exemptions
39 Blind: MultiplytheEnter
number in box 9 by $1,500 ...................................................................................................................... 39
the number claimed. Do not put a check mark.
7
Single

40 Dependents:
Multiply
the
box 10
by $2,300 ......................................................................................................... 40
8
Age 65
or number
over (youinand/or
spouse)
If completing lines 8
80 RCVD 41
81 PM
41 Qualifying9parents
and
grandparents:
.....................................................................................
Blind
(you
and/or spouse) Multiply box 11 by $10,000
through
11, also complete
Do not include
self orlines
spouse.
10
Dependents:
42 Arizona adjusted
gross income:
Subtract
38 through 41 lines
from line
37 ......................................................................
42
38 through
41.
11
Qualifying parents and grandparents
43 Deductions: (Box
Check
box and enter amount. See instructions on page 14 ....... 43I(check)
ITEMIZED
43S STANDARD 43
10): Dependent Information: Children and other dependents. For more space,
page 3.
 and complete
(a) on page 15 ............................................................................................................
(b)
(c)
(d)
(e)
(f)
44 Personal exemptions: See instructions
44
SOCIAL SECURITY NO. RELATIONSHIP NO. OF MONTHS
FIRST AND LAST NAME
 if this person  if you did not claim
Balance of Tax
LIVED IN YOUR did not qualify as a
this person
not list yourself
spouse.)
45 Arizona taxable income: (Do
Subtract
linesor43
and 44 from line 42. ...........................................................................................
45on your
dependent on your
federal return due to
HOME IN 2014
federal return
educational credits
46 Compute the tax using amount on line 45 and Tax Table X, Y or Optional Tax Tables ...................................................
46



48

10a
10b
Subtotal of
10ctax: Add lines 46 and 47 and enter the total .......................................................................................................
Qualifying
parents
and grandparents.
See instructions.
space, (check)  and complete page 3.
Family income(Box
tax11):
credit
(from your
worksheet
in the instructions
on pageFor
15)more
.......................................................................
49
Dependents
48
Place any required federal and AZ schedules or other documents after Form 140.
47 Tax from recapture of credits from Arizona Form 301, Part 2, line 38 ............................................................................
47


(a)
(b)
(c)
(d)
(e)
49
(f)
2014
STOP! If your
Arizona taxable
income is $50,000 or more, you must use Arizona Form 140.
Non-Arizona
municipal
interest....................................................................................................................................
13
Additions
Your First Name and Middle Initial
Last Name
Your Social Security Number
56
Property Tax
Credit
from
Form 140PTC
.........................................................................................................................
56
Enter
15 Total
federal
depreciation
............................................................................................................................................
15
your
16 Middle
Other
additions
income:
instructions
pagethe
7 and
include
your own
schedule
Spouse’s
First Name
and
Initial
(if box 4 orto
6Check
checked)
Last
Nameand on
Spouse’s
Social.......................................................
Security57
No.
57
Other
refundable
credits:
theSee
box(es)
enter
total
amount
.......................
1308-I 57234216573349 57
SSN(s).
1
17 Subtotal: Add lines 12 through 16 and enter the total ....................................................................................................... 17
58
Total
payments
and
credits: AddApt.lines
57 and
thecode)
total .......................................................
Current
Home Address
- number and
street,refundable
rural route
No. 52 through
Daytime
Phoneenter
(with area
18 Total net capital gain or (loss) included on line 12 ................................................................
18
00
94
59
TAX DUE:
line net
51 is
larger
than
linegain
58,or
subtract
line 58 on
from
line
51
and enter amount of tax due. Skip lines 60, 6100
and 62........
Last
Used in Last Four Prior Year(s) (if different) 19
19 IfTotal
short-term
capital
(loss
) included
lineNames
12...............................................
City, Town or Post Office
State
ZIP
Code
60 OVERPAYMENT:
line 58 iscapital
largergain
than
51,Enter
subtract
line 51
from
58 and
amount
20 Total netIflong-term
orline
(loss):
the amount
from
your line
worksheet,
lineenter
14, col.
(b) 20 of overpayment ........................
00
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
4  Married filing
joint return
21
Net
long-term
capital
gain
from
assets
acquired
after
December
31,
2011.
Enter
the
88
61 5 Amount
of line 60
to be applied to 2015 estimated tax...................................................................................................
Enter name of qualifying child or dependent on next line:
 Head of household:
amount from your worksheet, line 14, col. (d) ............................................................................... 21
00
62 Balance of overpayment: Subtract line 61 from line 60.......................................................................................................

2
3
Married filing
return:
Enter
name(.20)
and Social
above. .......................................................................................................
22separate
Multiply
line
21spouse’s
by 20%
andSecurity
enterNumber
the result
Solutions Teams Assigned to
Enter the number claimed. Do not put a check mark.
8
9
2
3
00
00
Recalculated
..............................................................................................................................
Domestic
Violence Shelter ...... 66
Political Gift..................... 67
ChildAge
Abuse
Prevention
.......
65Arizona depreciation
65 or 24
over
(you
and/or
spouse)
If completing lines 8
81 PM
80 RCVD
depreciation adjustment
through
11, ........................................................................................................................
also complete
National Guard Relief Fund . 68
00
Neighbors
Helping Neighbors.. 69
00 Special Olympics ............ 70
Dependents: Do not include self or spouse.
lines 13 through
16.
26 Adjustment for I.R.C. §179 expense
not allowed
........................................................................................................
State Parks
Qualifying
parents and
grandparents
Veterans’
Donations
Fund
... 71
00 I Didn’t
Pay Enough Fund........ 72
00 Sustainable
and Road Fund ............... 73
27 Interest
on Children
U.S. obligations
such as For
U.S.
savings
bonds
and
bills ................................................................
(Box 10): Dependent
Information:
and other dependents.
more
space, (check)
andtreasury
complete page
3.
(b)
(c)
(d)
(e)
(f)
Political Party
(if(a)LAST
amount
is entered
on line
67or- local
check
only
one
741
Elect
742 .................................
Democratic 743
28
for federal,
Arizona
state
government
pensions
(up
toAmericans
$2,500
NO.box):
OF MONTHS
FIRSTExclusion
AND
NAME
SOCIAL
SECURITY
NO.
RELATIONSHIP

if this
person
 if per
you didtaxpayer)
not claim
Blind (you 25
and/or2013
spouse)
Arizona
FORM 140A
17 Arizona adjusted gross income: Subtract lines 13, 14, 15, and 16 from line 12 ............................................................. 17
00
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
18 Standard deduction: If you checked filing status box 4 or 5, enter $10,010. If you checked box 6 or 7, 88
enter $5,009. ............... 18
00
82F
Check
box 82F See
if filing
under extension
19 Personal
exemptions:
instructions on page 7 ........................................................................................................... 19
00
Your Arizona
taxable
income on line 8 is $50,000 or more.
22 Family• income
tax credit
(from worksheet - see instructions on page 7).............................................................................. 22
• You
are claiming
estimated payments.
23 Balance
of tax:
Subtract line 22 from line 21. If less than zero, enter zero ......................................................................... 23
• You
aretax
taking
a subtraction
24 Arizona
income
withheld
during 2014for:
....................................................................................................................
24
81 PM
– active
duty military
YOUR
25
2014 SIGNATURE
Arizona
extension
paymentpay
(Form 204).............................................................................................................. 25
– wages
earned
Indian
reservation(s)
26 Increased
Excise Tax
Crediton(Form
140PTC or worksheet - see instructions on page 9) ....................................................... 26
Your Name (as shown on page 1)
Your Social Security Number
27 Property Tax Credit from Form 140PTC ...................................................................................................................... 27
FILING STATUS: Check one box.
28 Total payments and refundable credits: Add lines 24 through 27 and enter the total .................................................... 28
40 Enter
amountfiling
from joint
pagereturn
1, line 39 ........................................................................................................................... 40
4 the
Married
29 TAX DUE: If line 23 is larger than line 28, subtract line 28 from line 23, and enter amount of tax due. Skip line 30 .................... 29
41 SPOUSE’S
Recalculated
depreciation ................................................................................................................................. 41
SIGNATURE
5  SingleArizona
30 OVERPAYMENT: If line 28 is larger than line 23, subtract line 23 from line 28, and enter the amount of overpayment ............... 30
42 2013
Arizonaadjusted
depreciation
adjustment
6 Federal
gross
income ...........................................................................................................................
from your federal return .......................................................................... 426
Refundable Credit
Tax Due Total Payments and
or
Overpay

46 U.S.
Social Security
or Railroad
Retirement
Act ...................................................................................................
benefits included in your Arizona income ........................................... 469
9 Amount
of tax from
Optional
Tax Tables
47 10
Other
subtractions:
See credit
instructions
onworksheet
page 12 andsee
include
schedule ....................................................................
Family
income tax
(from
pageyour
5 ofown
instructions)
............................................................ 47
10
PAID
PREPARER’S
STREET
ADDRESS
48ADOR
Subtract
linesof
41tax:
through
47 from
40 .......................................................................................................................
11
Balance
Subtract
line line
10 from
line 9. If line 10 is moreAZ
than
line 9,
enter(2014)
zero .................................................. 48
11
10414
(14)
Form
140A
49 12
AgeArizona
65 or over:
Multiply
number induring
box 8 by
$2,100
................................................................ 49
00
income
taxthe
withheld
2014
.................................................................................................
12
50 13
Blind:
Multiply
the number
in box payment
9 by $1,500(Form
...............................................................................
50
00
2014
Arizona
extension
204)...........................................................................................
13
PAID
PREPARER’S
CITY
51 14
Dependents:
number
in box
10 by
$2,300 ..................................................................
51 STATE
00
IncreasedMultiply
ExcisetheTax
Credit
(from
worksheet
see page 5 of the instructions) .................................................
14
52 15
Qualifying
parents and grandparents:
Multiply
the number
in box 11 by $10,000........................... 52
00
Total payments/credits:
Add lines
12 through
14 ..........................................................................................
15
60
61
62
00
00
00
00
LINE 23
00
00
00
00
80 RCVD
DATE
OCCUPATION
00
00
00
00
00
00
00
DATE
SPOUSE’S OCCUPATION
00
00
00
00
Continued on page 2 
00
FIRM’S NAME00
(PREPARER’S IF SELF-EMPLOYED)
00
00
00
00
00
00
PAID PREPARER’S TIN
00
003
Page 1 of
00
00
ZIP CODE
PAID PREPARER’S PHONE NUMBER
00
LINE 11
(
00
If53you
are
sending
a payment
with this return, mail to Arizona Department
of Revenue,
AddTAX
linesDUE
49 through
52...........................................................................................................
53 17.
00 PO Box 52016, Phoenix, AZ, 85072-2016.
16
/ AMOUNT
OWED: If line 11 is more than line 15, subtract line 15 from line 11. Skip line
Include
the
payment
with
FormDepartment
140.
54 Multiply
line
53 bypayable
the Arizona
percentage
on line 28 of
....................................................................................................
00
Make
check
to Arizona
Revenue; include SSN on payment ............................ 54
16
55 17
Arizona
adjusted
gross income: Subtract
54 from
line
4811,
........................................................................................
REFUND
/ OVERPAYMENT:
If line 15line
is more
than
line
subtract line 11 from line 15 .......................................... 55
17
YOU CAN NOT CLAIM CREDITS
ON) THE SHORT FORM BUT LINE
11 WILL SHOW YOUR TOTAL TAX
00
If56you
are
a refund
or
owe deposit
noinstructions
tax,
owe placed
tax
but are
not sending
a payment,
mail to Arizona
Directexpecting
Deposit
of Refund:
Check
boxamount.
17A if yourSee
will beor
ultimately
account;
see
..17A 56
Deductions:
Check
box and
enter
on page 15
.........in56aIforeign
56Sinstructions
00 Department of Revenue, PO Box 52138, Phoenix, AZ, 85072-2138.
 ITEMIZED
 STANDARD
FORM 140PY
NUMBER
NUMBER
57 PersonalROUTING
exemptions:
See instructions of pageACCOUNT
16 .............................................................................................................
C  Checking or57
S  Savings 58
Subtract lines 56 and 57 from line 55 ............................................................................................
AZ Form 140 (2014)
00
00
59 Compute
the tax
line 58 and
or Y .................................................................................
59
00
I have read
this using
returnamount
and anyfrom
documents
withTax
it. Table
UnderXpenalties
of perjury, I declare that to the best of my knowledge
and belief, they are
60 Tax
from
recapture
of credits Declaration
from ArizonaofForm
301,(other
Part 2,than
linetaxpayer)
38 ............................................................................
true,
correct
and complete.
preparer
is based on all information of which preparer60has any knowledge. 00
61 Subtotal of tax: Add lines 59 and 60 and enter the total ....................................................................................................... 61
00

PLEASE SIGN HERE
Voluntary Gifts
FORM 140EZ
43 Adjustment
fordeduction
I.R.C. §179and
expense
not allowed
...........................................................................................................
43
7 Standard
personal
exemption:
If you checked filing status box 4, enter $14,210; if you
44 PAID
Interest
on filing
U.S. status
obligations
such$7,109
as U.S.
savings bonds and treasury bills ...................................................................
447
checked
box 5,
enter
...............................................................................................................
PREPARER’S
SIGNATURE
DATE
45 Arizona
statetaxable
lottery winnings
included
income
on
your
federal
return
(up
to
$5,000
only) ......................................
PLEASE
BEas
SURE
SIGN
THE
RETURN
ONzero
THE
REVERSE
SIDE OF THIS PAGE. 458
8 Arizona
income:
Subtract
line
7 fromTO
line
6.
If less
than
zero,
enter
.....................................................
98
ADOR
(14) income:
58 10413
Arizona taxable
62 Family income tax credit (from your worksheet on page 17 in the instructions) ....................................................................... 62
YOUR SIGNATURE
DATE
OCCUPATION
63 Credits from Arizona Form 301, Part 2, line 72 .............................................................................................................. 63
64
Balance of tax: Subtract lines 62 and 63 from line 61. If the sum of lines 62 and 63 is more than line 61, enter zero .................. 64
65 Arizona
income
tax withheld during 2014 .......................................................................................................................
65
SPOUSE’S
SIGNATURE
DATE
SPOUSE’S OCCUPATION
66 Arizona estimated tax payments for 2014 ...................................................................................................................... 66
67 2014 Arizona extension payment (Form 204)................................................................................................................. 67
PAID PREPARER’S SIGNATURE
DATE
NAME (PREPARER’S IF SELF-EMPLOYED)
68 Increased
Excise Tax Credit from worksheet: See instructions
on page 19FIRM’S
........................................................................
68
69 Other refundable credits: Check the box(es) and enter the total amount ....................... 691308-I 692342 693349 69
PAID PREPARER’S STREET ADDRESS
PAID PREPARER’S TIN
70 Total payments and refundable credits: Add lines 65 through 69 and enter the total ....................................................... 70
( 74 ....... )71
71 TAX DUE: If line 64 is larger than line 70, subtract line 70 from line 64, and enter amount of tax due. Skip lines 72, 73 and
PAID PREPARER’S CITY
STATE
ZIP CODE
PAID PREPARER’S PHONE NUMBER
72 OVERPAYMENT: If line 70 is larger than line 64, subtract line 64 from line 70, and enter amount of overpayment ....................... 72
•
If
you
are
sending
a
payment
with
this
return,
mail
to:
73 Amount of line 72 to be applied to 2015 estimated tax................................................................................................... 73
Arizona Department of Revenue, PO Box 52016, Phoenix, AZ, 85072-2016.
74 Include
Balance of
overpayment:
Subtract line 73 from line 72....................................................................................................... 74
the
payment with
Form 140EZ.
Solutions Teams Assigned to
75 - 85 Voluntary Gifts to:
00 Arizona Wildlife ............... 76
00
.................................... 75
• If you are expecting a refund or oweSchools
no tax,
or owe tax but are not sending a payment, mail to:
Child Abuse Prevention ....... 77
Domestic Violence Shelter ...... 78
00 Political Gift..................... 79
00
Arizona
Department of Revenue,00PO
Box 52138, Phoenix, AZ, 85072-2138.
00
00
00
00
00
00
00
00
00
00
00
00
00
LINE 61
CATHOLICEDUCATIONARIZONA.ORG
National Guard Relief Fund . 80
00 Neighbors Helping Neighbors.. 81
00 Special Olympics ............ 82
Sustainable State Parks
Veterans’ Donations Fund ... 83
00 I Didn’t Pay Enough Fund........ 84
00 and
Road Fund ............... 85
86 Political Party (if amount is entered on line 79 - check only one box): 861Americans Elect 862Democratic 863Libertarian
ADOR 10534 (14)
Penalty
22
00
23
24
00
25
00
26
00
27
Libertarian
744
28
I have read this return and any documents with it. Under penalties of perjury, I declare that to the best of my knowledge and belief, they are
00 all information of which preparer has any knowledge.
true, correct and complete. Declaration of preparer (other than taxpayer) is based on
20 Arizona taxable income: Subtract lines 18 and 19 from line 17 ......................................................................................... 20
You
use
Arizona
if:
21 STOP
Amount
of must
tax from
Optional
Tax Form
Tables 140
......................................................................................................................
21

Refund or
Amount Owed
59
14 Blind: Multiply the number in box 9 by $1,500 ................................................................................................................... 14
00
94
15 Dependents: Multiply the number in box 10 by $2,300 ......................................................................................................
15
00
Last Names Used in Last Four Prior Year(s) (if different)
City, Town or Post Office
State
ZIP Code
16 Qualifying parents and grandparents: Multiply the number in box 11 by $10,000 .............................................................. 16
00

EASE SIGN HERE
58
00
00
00
00
00
00
00
00
00
00
10
00
11
00
74
Republican
00




LIVED
IN
YOUR
did not qualify as a
this person on your
(Do not list yourself or spouse.)
dependent
on(up
your to
federal
return due
to
HOMEfederal
IN 2014
Arizona state
lotteryand
winnings
included
as income Health
on your
return
$5,000
only)
................................... 29
00
75 Estimated29payment
penalty
Arizona
Long-Term
Care
Savings
Account
federal return
educational credits(AZLTHSA) penalty ...................... 75
30 U.S. Social Security or Railroad Retirement Act benefits included as income
on your
00

 federal return (taxable amount) 30
a
7610
761Annualized/Other 762Farmer or Fisherman 763Form 221 included 764AZLTHSA Penalty


10b
31 Certain wages of American Indians .............................................................................................................................
31
00


10
c
77 Add lines32
63 through
73for
and
75;service
enterasthe
total..............................................................................................................
77 00
received
active
aFormember
of (check)
the reserves,
national
or the U.S. armed forces .................... 32
(Box 11): QualifyingPay
parents
and grandparents.
See instructions.
more space,
pageguard
3.
 and complete
(b)less
(c) page
(d)
(e) an
(f) ..........................................................
78 REFUND:
line 77
from
lineSOCIAL
62. SECURITY
IfSee
than zero,
enter
amount
onentry
linehere
79
78 00
33 Subtract
Net(a)
operating
loss
adjustment:
instructions
on
11 before
youowed
make
............................................... 33
NO. RELATIONSHIP NO. OF MONTHS
ArizonaFIRST
FormAND LAST NAME
 if FOR CALENDAR
YEAR
if
LIVED IN YOUR
(Do not list yourself or spouse.)
age 65 or over
in 2014
34 Contributions
toCheck
529 Personal
College
Savings
Plans
...............................................................................................................
34
00
Resident
Tax
Return
(EZ
HOME
IN Form)
2014
Direct
Deposit
of Refund:
box 78
AIncome
if your
deposit
will be
ultimately
placed
in died
a foreign
account; see instructions.
78A
2014
140EZ
ROUTING
NUMBER
ACCOUNT
NUMBER
35 Other
Subtractions: See instructions on
page 12 and
include your own schedule
35
00
11a
 ................................................................

or
C Checking
Your First Name and Middle Initial
Last Name
Your Social Security Number
Enter
11b 98
36 Subtract lines 22 through 35 from line 17. Enter the total ..........................................................................................
36
00


1
S  Savings
your
ADOR 10413 (14)
AZ Form
Page 1 of 3
11c
140 (2014) 
Spouse’s First Name and Middle Initial (if box 4 is checked)
Last Name
Spouse’s Social Security No.
79
59 and
77.
Make check payable to
Arizona12Department of Revenue;
write your SSN on payment,
SSN(s).
12 AMOUNT
Federal adjustedOWED:
gross incomeAdd
(from lines
your federal
return)
...................................................................................
00
1
13 and
Age 65include
or over: Multiply the
number in box 8 by $2,100 .................................................................................................... 13
00
your
return
79
Current
Home Address -with
number
and street,
rural.................................................................................................................................................
route
Apt. No.
Daytime Phone (with area code)
6
637- 
73 Single
Voluntary
Gifts
to:gain derived from investment
00 Arizona Wildlife ............... 64
63
Schools in
....................................
23 Net
capital
qualified small business..........................................................................
Subtractions
Tax Due or
13
140A
55
Increased
Excise
Tax
Credit
(Form 140PTC or worksheet - see instructions on page 18) ........................................................ 55
Check box14
82F
if filing
under
extension
82F
Ordinary
income
portion of lump-sum distributions excluded on your federal return .................................................. 14
EXEMPTIONS FILING STATUS
Voluntary Gifts
Overpayment
Refundable
Credits
DO NOT
STAPLE ANY ITEMS TO
THE RETURN.
12 Federal Resident
adjusted gross
income
(from your
federal return)
12
FOR CALENDAR YEAR
Arizona Form
Personal
Income
Tax Return
(Short...................................................................................
Form)
54 2014
Arizona
extension
payment
(Form
204).................................................................................................................
54
1
Dependents
Penalty
Refund or
11b


53 Arizona estimated
tax payments for 2014 ......................................................................................................................
53
Exemptions
Tax Due or
Total Payments and
PLEASE
SIGN
HERE
Owed
Place any
required federal
orofother
after Form 140EZ.
Place any– cont.
required
federal
and
AZ schedules
or otherANY
documents
140A.
DO NOT STAPLE
ITEMS Amount
TOafter
THE Form
RETURN.
Balance
Tax documents
Subtractions
from page
1
Overpayment
Refundableand
CreditsAZ schedules
Exemptions
52 Arizona income
tax withheld during 2014 .......................................................................................................................
52
11a


Balance of Tax
Total Payments and
50 Credits from Arizona FormFIRST
301,AND
Part
2,NAME
line 72 ..............................................................................................................
50if
LAST
SOCIAL SECURITY NO. RELATIONSHIP NO. OF MONTHS
 if

LIVED IN YOUR
(Do not list yourself or spouse.)
age 65 or over
died in 2014
HOME48,
IN 2014
51 Balance of tax: Subtract lines 49 and 50 from line 48. If the sum of lines 49 and 50 is more than line
enter zero .................. 51
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
00
864
Republican
1-888-TAX-CRDT (888-829-2738)
87 Estimated payment penalty and Arizona Long-Term Health Care Savings Account (AZLTHSA) penalty ......................
88 881Annualized/Other 882Farmer or Fisherman 883Form 221 included 884AZLTHSA Penalty
89 Add lines 75 through 85 and 87; enter the total.............................................................................................................
90 REFUND: Subtract line 89 from line 74. If less than zero, enter amount owed on line 91 ..........................................................
Direct Deposit of Refund: Check box 90A if your deposit will be ultimately placed in a foreign account; see instructions. 90A
ROUTING NUMBER
ACCOUNT NUMBER
C Checking or
98
S  Savings
91 AMOUNT OWED: Add lines 71 and 89. Make check payable to Arizona Department of Revenue; write your SSN on payment,
and include with your return .................................................................................................................................................


87
00
89
90
00
00
91
00
I have read this return and any documents 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.
YOUR SIGNATURE
DATE
OCCUPATION
SPOUSE’S SIGNATURE
DATE
SPOUSE’S OCCUPATION
PAID PREPARER’S SIGNATURE
PAID PREPARER’S STREET ADDRESS
DATE
FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED)
PAID PREPARER’S TIN
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