Arizona Form     Credit for Business Contributions by an S Corporation 
                              to School Tuition Organizations for Displaced Students                                                    2021
               341-I
                                     or Students with Disabilities - Individual
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, 140PY, 140NR, 140X, 140-SBI, 140NR-SBI, 140PY-SBI or 140X-SBI                         Your Social Security Number 
                                                                                                                       
Spouse’s Name as shown on Form 140, 140PY, 140NR, 140X, 140-SBI, 140NR-SBI, 140PY-SBI or 140X-SBI (if a joint return) Spouse’s Social Security Number 
                                                                                                                       
Part 1 School Tuition Organization Information
  Check if you are claiming a pro rata credit from more than one S corporation.  Complete and include a separate Part 1 for each 
   additional S corporation.
   I am claiming a credit for my pro rata share of contributions made by the S corporation named below to the following 
   school tuition organizations:
   S corporation name:                                                  EIN: 
   If you need more space to list all school tuition organizations for which contributions were made by the S corporation identified 
   above, complete an additional schedule and include it with the credit form.
                                (a)                                                               (b)
                             School Tuition Organization Name                                 Credit Approval Number
  1

2

3

4

5

6

7

8

9

10

11 Amount of individual shareholder’s pro rata share of qualified contributions made to school tuition 
   organizations from the S corporation listed above ............................................................................... 11           00

                                                                                                                                        Continued on page 2 

ADOR 11240 (21)

 Your Name (as shown on page 1)                                                         Your Social Security Number

 Part 2 Current Year’s Credit
 12 Current year’s credit:  Enter the amount from Part 1, line 11.  If you are claiming a current year’s credit 
    from more than one S corporation, include the amount(s) on line 11 from each additional Part 1 schedule 
    and enter the total.......................................................................................................................................  12        00

 Part 3 Available Credit Carryover
                (a)               (b)                             (c)                              (d)
        Taxable Year            Original Credit Amount Amount Previously Used           Available Carryover:
      from which you are                                                                Subtract column (c) from 
      carrying the credit                                                               column (b).

 13          2016                     00                                            00                      00

 14          2017                     00                                            00                      00

 15          2018                     00                                            00                      00

 16          2019                     00                                            00                      00

 17          2020                     00                                            00                      00

 18 Total Available Carryover:  Add lines 13 through 17, column (d)..............    18                     00

 Part 4 Total Available Credit
 19 Current year’s credit:  Enter the amount from Part 2, line 12.
    • If you did not make the Small Business Income election:  Enter this amount on Arizona Form 301,  
      Part 1, line 19, column (a).
    • If you made the Small Business Income election:  Enter this amount on Arizona Form 301-SBI,  
      Part 1, line 14, column (a)........................................................................................................................   19            00
 20
    Available Carryover:  Enter the amount Part 3, line 18.
    • If you did not make the Small Business Income election:  Enter this amount on Arizona Form 301,  
      Part 1, line 19, column (b).
    • If you made the Small Business Income election:  Enter this amount on Arizona Form 301-SBI,  
      Part 1, line 14, column (b).........................................................................................................................  20            00

 21 Total Availabe Credit:  Add lines 19 and 20.
    • If you did not make the Small Business Income election:  Enter this amount on Arizona Form 301,  
      Part 1, line 19, column (c).
    • If you made the Small Business Income election:  Enter this amount on Arizona Form 301-SBI,  
      Part 1, line 14, column (c)........................................................................................................................  21             00

                                                           Print Form
 ADOR 11240 (21)                                       AZ Form 341-I (2021)                                                                                        Page 2 of 2