Enlarge image | Arizona Form Individual Amended Income Tax Return FOR CALENDAR YEAR 140X For Forms 140, 140A, 140EZ, 140NR and 140PY 2022 OR FISCAL YEAR BEGINNING M M D D 2 0 2 2 AND ENDING M M D D Y Y Y Y . 66 Your First Name and Middle Initial Last Name Your Social Security Number Enter 1 your Spouse’s First Name and Middle Initial (if box 4 or 6 checked) Last Name Spouse’s Social Security No. SSN(s). 1 Current Home Address - number and street, rural route Apt. No. Daytime Phone (with area code) 2 94 City, Town or Post Office State ZIP Code Last Names Used in Last Four Prior Year(s) (if different) 3 97 Check a box to indicate both filing and residency status: REVENUE USE ONLY. DO NOT MARK IN THIS AREA. 4 Married filing joint return 4a Injured Spouse Protection of Joint Overpayment 88 5 Head of household: Enter name of qualifying child or dependent on next line: FILING STATUS 6 Married filing separate return: Enter spouse’s name and Social Security Number above. DO NOT STAPLE ANY ITEMS TO THE RETURN. 7 Single 8 Resident Enter the number claimed. Do not check 9a Nonresident 9b Composite 13 Age 65 or over .................................. 10 Nonresident active military 14 Blind .................................................. 81 PM 80 RCVD 11 Part-year resident 15a Dependents Under 17 15b 17 & over RESIDENCY 12 Part-year resident active military EXEMPTIONS 16 Qualifying parents or grandparents .. 17 Federal adjusted gross income (from your federal return)...................................................................................... 17 00 18 Small Business Income: Residents only: check box18N for no change; check box 18S for a new election; check box 18C if you are changing the original amount reported. See instructions............................................... 18 00 19 Modified federal adjusted gross income: Residents: Subtract line 18 from line 17.......................................................... 19 00 20 Nonresidents and part-year residents only: Enter Arizona gross income here.............................................................. 20 00 20a Arizona income ratio: If you checked box 9a, 10, 11 or 12, divide line 20 by line 17 and enter the result (not over 1.000) 20a 21 Small Business Income: Nonresidents and part-year residents only: check box 21N for no change; check box 21S for a new election; check box 21C if you are changing the original amount reported. See instructions...... 21 00 22 Modified Arizona Gross Income: Nonresidents and part-year residents: Subtract line 21 from line 20................... 22 00 23 Additions to Income. See instructions............................................................................................................. 23 00 24 Subtotal: Residents: Add lines 19 and 23. Nonresidents and part-year residents: Add lines 22 and 23................... 24 00 25 Subtractions from Income. See instructions ..................................................................................................................... 25 00 26 Total net capital gain or (loss). See instructions .................................................................... 26 00 27 Total net short-term capital gain or (loss). See instructions ...................................................27 00 28 Total net long-term capital gain or(loss). See instructions..........................................................28 00 29 Net long-term capital gain from assets acquired after December 31, 2011. See instructions ... 29 00 30 Multiply line 29 by 25% (.25) and enter the result .......................................................................................................... 30 00 31 Net capital gain derived from investment in qualified small business............................................................................. 31 00 32 Contributions to: 32a 529 College Savings Plans 00 32b 529A (ABLE accounts) 00 add 32a and 32b....... 32c 00 33 Arizona adjusted gross income: Subtract lines 25, 30, 31, and 32c from line 24. If less than zero, enter “0” ........................ 33 00 34 Deductions: Check box and enter amount. See instructions .............................. 34I ITEMIZED 34S STANDARD 34 00 35 If you checked box 34S and claim charitable contributions, check 35C Complete page 4. See instructions ............... 35 00 36 Arizona taxable income: Subtract lines 34 and 35 from line 33. If less than zero, enter “0” ..................................................... 36 00 37 Tax from tax table: Table X and Y (140, 140NR or 140PY) Optional Table (140, 140A or 140EZ) ................ 37 00 38 Tax from recapture of credits from Arizona Form 301, Part 2, line 32 ............................................................................ 38 00 39 Subtotal of tax: Add lines 37 and 38. Enter the total ........................................................................................................... 39 00 40 Family income tax credit (AZ residents only) 40a 00 Dependent Tax Credit. 40b 00 40c 00 41 Nonrefundable credits from Arizona Form 301, Part 2, line 64....................................................................................... 41 00 42 Balance of tax: Subtract lines 40c and 41 from line 39. If the sum of lines 40c and 41 is more than line 39, enter “0” ................. 42 00 43 Withholding, Estimated, and Extension Payments 43a 00 Claim of Right 43b 00 43c 00 44 Arizona residents only: Increased Excise Tax Credit 44a 00 Property Tax Credit 44b 00 44c 00 45 Other refundable credits: Check the box(es) and enter the total amount ......................................... 451308-I 452349 45 00 46 Payment with original return plus all payments after it was filed .................................................................................... 46 00 47 Total payments and refundable credits: Add lines 43c, 44c, 45 and 46. Enter the total ................................................... 47 00 Place any required federal and AZ schedules or other documents after Form 140X. ADOR 10573 (22) Form 140X (2022) Page 1 of 5 |
Enlarge image | YourY Name (as shown on page 1)our Name (as shown on page 1) YourYSocial Security Numberour Social Security Number 48 Overpayment from original return or as later adjusted. See instructions .......................................................................... 48 00 49 Balance of credits: Subtract line 48 from line 47. Enter the difference ................................................................................... 49 00 50 OVERPAYMENT: If line 42 is less than line 49, subtract line 42 from line 49. Enter amount of overpayment .............................. 50 00 51 Amount of line 50 to be applied to 2023 estimated tax. See instructions. If zero, enter “0” ......................................... 51 00 52 REFUND: Subtract line 51 from line 50. If less than zero, enter amount owed on line 53 ......................................................... 52 00 Direct Deposit of Refund: Check box 52A if your deposit will be ultimately placed in a foreign account; see instructions. 52A 98 C Checking or ROUTING NUMBER ACCOUNT NUMBER S Savings 53 AMOUNT OWED: If line 42 is more than line 49, subtract line 49 from line 42. Enter the amount owed......................................... 53 00 54 Check box 54 if this amended return is the result of a net operating loss, and enter the year the loss was incurred .... 54 2 0 Y Y Complete Parts 1(A) and 1(B), Part 2 and Part 3 to report changes made to your original tax return or most recent amended tax return and the reason(s) for each change. NOTE: You must complete page 5, Dependent and Other Exemption Information, if you are reporting dependents (page 1, box 15a or 15b), or qualifying parents and grandparents (page 1, box 16.) You must also complete page 5, Part 3 if you claim Other Exemptions on page 1, line 25. If you do not complete page 5, your dependents and other exemptions may be denied. Do not count or list yourself or your spouse as dependents. INCOME, DEDUCTIONS, CREDITS: In column (a), list the items you are changing. In column (b), enter the amount claimed on your original return or most recent amended return. In column (c), enter the amount of the change. In column (d), enter the corrected amount for the item you are changing. (a) (b) (c) (d) INCOME, DEDUCTIONS, AND CREDITS YOU ARE CHANGING ORIGINAL AMOUNT AMOUNT TO CORRECTED If you are rescinding your small business election, check box 55R REPORTED ADD OR SUBTRACT AMOUNT PART 1 (A) See these instructions for more information regarding rescinding the election. 55a $ $ $ 55b $ $ $ 55c $ $ $ NET CAPITAL GAIN OR (LOSS): If you are changing any amount on lines 56a through 56e, complete columns (b), (c), and (d). (a) (b) (c) (d) ITEM ORIGINAL AMOUNT AMOUNT TO CORRECTED REPORTED ADD OR SUBTRACT AMOUNT 56aTotal net capital gain or (loss) reported on Form 140, line 20; Form 140NR, line 34; or Form 140PY, line 33 .................. $ $ $ 56bTotal net short-term capital gain or (loss) reported on PART 1 (B) Form 140, line 21; Form 140NR, line 35; or Form 140PY, line 34 .................. $ $ $ 56cTotal net long-term capital gain or (loss) reported on Form 140, line 22; Form 140NR, line 36; or Form 140PY, line 35 .................. $ $ $ 56dNet long-term capital gains from assets acquired after December 31, 2011 reported on Form 140, line 23; Form 140NR, line 37; or Form 140PY, line 36 $ $ $ 56eAmount of allowable subtraction reported on Form 140, line 24; Form 140NR, line 38; or Form 140PY, line 37 ................................................ $ $ $ 57 REASON FOR THE CHANGE: Give the reason for each change listed in Part 1 (A) and B): PART 2 Check box 58a if your address on this amended return is not the same as it was on your original return (or latest return filed). Complete Part 3 with your current address. 58b Name 58c Number and Street, R.R. Apt. No. PART 3 d City, Town or Post Office State ZIP Code 58 ADOR 10573 (22) Form 140X (2022) Page 2 of 5 |
Enlarge image | Your Name (as shown on page 1) Your Social Security Number Sign and date your return. If you paid someone to prepare your return, that person must also sign and date the return. The paid preparer must provide their street address, Paid Preparer TIN and phone number. Under penalties of perjury, I declare that I have read this return and any documents with it, and 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 DATE FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED) PLEASE SIGN HEREPAID PREPARER’S STREET ADDRESS PAID PREPARER’S TIN PAID PREPARER’S CITY STATE ZIP CODE PAID PREPARER’S PHONE NUMBER • If you are sending a payment with this return, mail to: Arizona Department of Revenue PO Box 52016 Phoenix, AZ 85072-2016 Include the payment with Form 140X. Make check payable to Arizona Department of Revenue; write your SSN, Form 140X and tax year on payment. • 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 ADOR 10573 (22) Form 140X (2022) Page 3 of 5 |
Enlarge image | Your Name (as shown on page 1) Your Social Security Number 2019 Form 140PY - Standard Deduction Increase You must complete this worksheet if 2022 Form 140X - Standard Deduction Increase for Charitable Contributions You must complete this worksheet if you are taking an increased standard deduction for charitable contributions. Include the completed worksheet with your tax return, when filed. If you do not include the completed worksheet, your standard deduction will not be increased. Taxpayers electing to take the Standard Deduction may increase the standard deduction amount by 27% (.27) of the total amount of the taxpayer’s charitable deductions that would have been allowed if the taxpayer elected to claim itemized deductions on the Arizona tax return. Charitable contributions (lines 1C, 2C, and 3C) are those gifts allowed on federal Form 1040 Schedule A (Gifts to Charity) that you would have claimed had you elected to take itemized deductions on your federal return. NOTE 1: A part-year resident taxpayer may only include those charitable contributions that are incurred and paid while an Arizona resident plus the amount of such gifts from Arizona sources incurred and paid during the part of the year while an Arizona nonresident. Anonresidenttaxpayer must prorate the increased standard deduction by his/her Arizona income ratio computed on page 1, line 20a. NOTE 2: You must reduce your contribution amount by the total charitable contributions you made during January 1, 2022 through December 31, 2022 for which you are claiming an Arizona tax credit under Arizona law for the current tax year return or claimed on the prior tax year return. Enter this amount on line 5C. NOTE 3: If you itemized deductions on your federal return (1040 Schedule A) and were required to adjust the amount of your allowable contributions on your federal 1040 Schedule A for the amount claimed as a tax credit on your Arizona income tax return, include the amount of the federal contribution adjustment to line 1C and enter the amount of the Arizona tax credit on line 5C. Complete the worksheet to determine your allowable increased standard deduction for charitable contributions. 1C 2022 Gifts by cash or check.................................................................................. 1C 00 2C 2022 Other than by cash or check...................................................................... 2C 00 3C Carryover from prior year.................................................................................... 3C 00 4C Add lines 1C through 3C and enter the total....................................................... 4C 00 5C Total charitable contributions made in 2022 for which you are claiming a credit under Arizona law for the current (2022) or prior tax year (2021)....................... 5C 00 6C Subtract line 5C from line 4C and enter the difference. If less than zero, enter “0”....................................................................................................................... 6C 00 7C Multiply line 6C by 27% (.27) and enter the result............................................. 7C 00 8C Nonresidents filing Form 140NR: Enter your Arizona income ratio from page 1, line 20a. All other taxpayers enter 1 000............................................... 8C 9C Multiply line 7C by the percentage on line 8C and enter the result.................... 9C 00 • Enter the amount shown on line 9C on page 1, line 35 • Be sure to check box 34S for Standard Deduction on line 34. • Check box 35C for charitable contributions on line 35. If you do not check this box, you may be denied the increased standard deduction. ADOR 10573 (22) Form 140X (2022) Page 4 of 5 |
Enlarge image | Your Name (as shown on page 1) Your Social Security Number 2019 Form 1402022 140X Dependent and Other Exemption Information Include page 5 with your amended return if: • You are reporting dependents (box 15a and 15b) on page 1. • You are reporting qualifying parents and grandparents (box 16) on page 1. • You are taking a deduction for Other Exemptions on page 1, line 25 (Subtractions from Income). Part 1: Dependents (Box 15a and 15b) - (Forms 140, 140A, 140NR, and 140PY) Information used to compute your allowable Dependent Tax Crediton page 1, line 40 (box 40b). (a) (b) (c) (d) (e) (f) FIRST AND LAST NAME SOCIAL SECURITY RELATIONSHIP NO. OF MONTHS Dependent Age IF YOU DID NOT CLAIM THIS PERSON (Do not list yourself or spouse.) NUMBER LIVED IN YOUR included in: ON YOUR FEDERAL HOME IN 2022 RETURN DUE TO 1 2 EDUCATIONAL (Box 15a) (Box 15b) CREDITS 15c 15d 15e 15f 15g 15h 15i 15j 15k 15l 15m 15n Part 2: Qualifying parents and grandparents (Box 16) - (Forms 140, 140A, and 140PY) Information used to compute your exemption included in Subtractions from Income, line 25. (a) (b) (c) (d) (e) (f) FIRST AND LAST NAME SOCIAL SECURITY RELATIONSHIP NO. OF MONTHS IF AGE 65 OR IF DIED IN (Do not list yourself or spouse.) NUMBER LIVED IN YOUR OVER 2022 HOME IN 2022 16a 16b 16c 16d 16e 16f Part 3: Other Exemptions - (Forms 140, 140A, 140NR, and 140PY) Information used to compute your other exemptions included in Subtractions from Income, line 25. (a) (b) (c) (d) FIRST AND LAST NAME SOCIAL SECURITY AGE 65 OR OVER STILLBORN (Do not list yourself or spouse.) NUMBER (see instructions) CHILD IN 2022 C1 C2 1 2 3 4 5 6 7 8 9 10 ADOR 10573 (22) Form 140X (2022) Page 5 of 5 |