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                  Arizona Form  
                                                        Credit for Donations to the 
                  340                                   Military Family Relief Fund                                                                             2021
Include with your return.
         For the calendar year 2021 or fiscal year beginning       M M D D    2 0 2 1  and ending            M M D D Y Y Y Y  .
Your Name as shown on Form 140, 140NR, 140PY, or 140X                                                 Your Social Security Number 
                                                                                                       
Spouse’s Name as shown on Form 140, 140NR, 140PY, or 140X (if a joint return)                         Spouse’s Social Security Number 
                                                                                                       
    1Did you receive a receipt from the Arizona Department of Veterans’ Services that indicates that your                                                       YES NO
     contribution qualifies for this credit?.................................................................................................................  1
      If you answered “No,” STOP!  You do not qualify for this credit.

NOTE:  If your receipt does not show which account (pre-9/11 or post-9/11) your donation was deposited into, enter the amount of the 
donation on line 3 (post-9/11 donation).  
2    Qualified donations made to the pre-9/11 veterans subaccount during 2021 ...............................................                       2                 00
3    Qualified donations made to the post-9/11 veterans subaccount during 2021 ..............................................                       3                 00
4    Total qualified donations made during 2021.  Add lines 2 and 3.  Enter the total ..........................................                    4                 00
5    Single taxpayers or heads of household, enter $200 here.  Married taxpayers filing a joint return, enter 
     $400 here. Married taxpayers filing a separate return, enter $200. ..............................................................              5                 00
6    Current year’s credit before tax:  Enter the smaller of line 4 or 5.  Also, enter this amount on Arizona  
     Form 301, Part 1, line 18, columns (a) and (c) ..............................................................................................  6                 00

                                                           Instructions                               Print Form

For information or help, call one of the numbers listed:                1.  The amount you donated to the fund during the taxable year.
Phoenix                                         (602) 255-3381          2.  If you are a single taxpayer or a head of household, $200. 
From area codes 520 and 928, toll-free          (800) 352-4090          3.  If you are married filing a joint return, $400.  If you are filing 
                                                                              separate returns, you each may claim only 1/2 of the credit  
Tax forms, instructions, and other tax information                            that would have been allowed on a joint return (up to a  
If you need tax forms, instructions, and other tax information,               maximum of $200 each). 
go to the department’s website at www.azdor.gov.                        4.  Your tax liability for the taxable year.
                                                                      There is no carry forward for this credit.  You must claim and use 
Income Tax Procedures and Rulings
These instructions  may refer to the department’s income              this credit on the tax return filed for the taxable year for which you 
tax procedures and rulings for more information.  To view or          made your donation.
print these, go to our website and click on Reports and Legal         This credit is available only to individuals.  Corporations may not 
Research then click on Legal Research and select a document           claim this credit.  A partnership may not pass the credit through to 
and category type from the drop down menus.                           its partners.  An S Corporation may not pass the credit through to 
                                                                      its shareholders.
Publications
To view or print the department’s publications,  go to our            You cannot claim both a tax credit and an itemized deduction for 
website and click on   Reports and Legal Research       then click    your donation.
on Publications.                                                      Before you claim this credit, you must have received a receipt from 
For more information about the Military Family Relief Fund, visit     the ADVS.  Your receipt must show all of the following:
the Arizona Department of Veterans’ Services (ADVS) website at          •  your full name and address,
www.azdvs.gov.                                                          •  the last four digits of your Social Security Number (SSN),
                                                                        •  the amount you donated, 
General Instructions                                                    •  the amount designated  to each fund (pre-9/11 and/or  
                                                                          post-9/11), and
NOTE:        You  must also  complete  Arizona  Form 301,               •  your donation qualifies for the tax credit.
Nonrefundable  Individual  Tax Credits  and  Recapture, and 
include Forms 301 and 340 with your tax return to claim this          Military Family Relief Fund
credit.                                                               The ADVS administers the Military Family Relief Fund.  Donations 
                                                                      deposited into the pre-9/11 veterans subaccount will be used to 
Arizona law allowing for a tax credit for cash donations made to      provide financial assistance.  The service member of an applying 
the Military Family Relief Fund was extended to taxable year 2026.    family must have been deceased, wounded or injured or become 
The ADVS established two subaccounts (pre-9/11 and post-9/11)         seriously ill on or  before September 11,  2001, been deployed 
for which a donor must designate which account the donor wishes       from a military base in this state, claimed this state as the service 
the donation to be deposited into. If your donation qualifies for the member’s home of record, or been a member of the  Arizona 
credit, your credit will be the smaller of 1 through 4.               National  guard  at the time of deployment.   If discharged  from 
ADOR 10395 (21)                                                                                                                                     Continued on page 2 



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military service, the service member must have been discharged         Line 2 
under honorable conditions.  The assistance shall be based on 
financial need up to twenty thousand dollars per family.               Enter the amount of qualified donations that you (and if married, 
                                                                       your spouse) made to the pre-9/11 veterans subaccount during 
Donations deposited into the post-9/11 veterans subaccount will        2021.  
be used to provide financial assistance.  The service member of 
an applying family must have been deceased, wounded or injured         Line 3 
or become seriously ill after September 11, 2001, been deployed        Enter the amount of qualified donations that you (and if married, 
from a military base in this state, claimed this state as the service  your spouse) made to the post-9/11 veterans subaccount during 
member’s home of record, or been a member of the  Arizona              2021.  
National  Guard at the time of deployment.   If discharged  from 
military service, the service member must have been discharged         Line 4 
under honorable conditions.  The assistance shall be based on          Enter the total qualified donations you (and if married, your spouse) 
financial need up to twenty thousand dollars per family.               made during 2021.  Add lines 2 and 3. Enter the total.
Your donations may qualify for this income tax credit.  Donations      Line 5 
will  qualify  for the credit if the total amount donated  during  the 
calendar year has not exceeded one million dollars.                    Single taxpayers or head of  household, enter $200.   Married 
                                                                       taxpayers filing a joint return, enter $400. Married taxpayers filing 
Donations  made  once  the total donations  for the calendar  year     a separate return, enter $200.
reach one million dollars will not qualify for  the  credit.   The 
determination of whether a donation will qualify for the credit is     Line 6 
made on a first come, first served basis by the ADVS.                  Current year’s credit before tax: Enter the smaller of line 4 or 5. 
The ADVS will provide you with a receipt that will let you know if     If you and your spouse are filing separate returns, you each may 
your donation qualifies for the credit.  The ADVS will also send a     claim only 1/2 of the credit that would have been allowed on a joint 
copy of that receipt to the Arizona Department of Revenue.             return (up to a maximum of $200 each). 
Line-by-Line Instructions                                              Also, enter this amount on Arizona Form 301, Part 1,  line 18, 
                                                                       columns (a) and (c). 
Enter your name and SSN as shown on  Arizona Forms  140, 
140PY, 140NR, or 140X.
All returns, statements, and other documents filed with the 
department  require a taxpayer identification  number  (TIN).  The 
TIN for an individual is the taxpayer’s SSN or an Internal Revenue 
Service (IRS) individual  taxpayer identification  number  (ITIN). 
Taxpayers that fail to include their identification number may be 
subject to a penalty.
Line 1 
To claim this credit, you must have received a receipt from the 
ADVS that indicates that your donation  qualifies  for the credit.  
Answer the question on line 1.  
•  If your answer  to this question is “No”, STOP, you do not 
qualify for the credit.  
•  If  your answer to this question is “Yes”, complete lines 2 
through 6.

ADOR 10395 (21)






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