Arizona Resident Personal Income Tax (Short) Package

Resident Personal Income Tax (Short) Package
Arizona Form 140A
	
	

	
	
	

140A

FOR CALENDAR YEAR

Resident Personal Income Tax Return (Short Form)

STOP! If your Arizona taxable income is $50,000 or more, you must use Arizona Form 140.

Check box 82F if filing
82F
Your First Name and Middle Initial

2023

under extension
Last Name

Spouse’s First Name and Middle Initial (if box 4 or 6 checked)

Last Name

1
Current Home Address - number and street, rural route

Apt. No.

State

ZIP Code

Spouse’s Social Security No.

Daytime Phone (with area code)
94

2
City, Town or Post Office

Your Social Security Number

Enter
your
SSN(s).

1

Last Names Used in Last Four Prior Year(s) (if different)

3

97

EXEMPTIONS FILING STATUS

DO NOT STAPLE ANY ITEMS TO THE RETURN.
	
	

Arizona Form

4	
5	

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6	
7	

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8	
9	
10a	
11a		

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Married filing joint return 4a
Injured Spouse Protection of Joint Overpayment
Head of household. Enter name of qualifying child or dependent on next line:

Age 65 or over (you and/or spouse) If completing lines 8, 9, and 11a, also complete lines 13,
14, and 16. For lines 10a and 10b, also complete line 21.
80 RCVD
81 PM
Blind (you and/or spouse)
Dependents: Under age of 17.
10b
Dependents: Age 17 and over.
Qualifying parents and grandparents
(Box 10a and 10b): Dependent Information. See instructions. For more space, check the box  and complete page 3.

Dependents
Qualifying Parentsand
Grandparents

Exemptions
Balance of Tax

(Do not list yourself or spouse.)

(b)

SOCIAL SECURITY
NUMBER

(c)

(d)

RELATIONSHIP NO. OF MONTHS
LIVED IN YOUR
HOME IN 2023

(e)

(f)

included in:

this person on your
federal return due to
educational credits

Dependent Age  if you did not claim
1

2

(Box 10a ) (Box 10b)

10c
10d
10e

	

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(Box 11a): Qualifying parents and grandparents. See instructions. For more space, check the box  and complete page 3.
(a)
FIRST AND LAST NAME

(Do not list yourself or spouse.)

(b)

SOCIAL SECURITY
NUMBER

(c)

(d)

RELATIONSHIP NO. OF MONTHS
LIVED IN YOUR
HOME IN 2023

11b
11c
11d
	12
	13
	14
	15
	16
	17
	18
	19
	20
	21
	22
	23
	24
	25
	26
	27
	28
	29
	30

Total Payments and
Refundable Credit
or
Overpay

88

Married filing separate return. Enter spouse’s name and Social Security Number above.
Single
	Enter the number claimed. Do not put a check mark.

(a)
FIRST AND LAST NAME

Place any required
federal and AZ schedules or other documents after Form 140A. 
Tax Due

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

(e)

 if

ADOR 10414 (23)	

PLEASE BE SURE TO SIGN ON PAGE 2 OF THIS RETURN.

AZ Form 140A (2023)

Print Form

(f)

 if

age 65 or over

died in 2023

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Federal adjusted gross income (from your federal return)....................................................................................
Age 65 or over: Multiply the number in box 8 by $2,100.....................................................................................................
Blind: Multiply the number in box 9 by $1,500.....................................................................................................................
Other Exemptions: See instructions. ......15E
Multiply the number in box 15E by $2,300.....................................
Qualifying parents and grandparents: Multiply the number in box 11a by $10,000.............................................................
Arizona adjusted gross income: Subtract lines 13, 14, 15, and 16 from line 12. If less than zero, enter “0”..........................
Standard deduction: If you checked filing status box 4 enter $27,700; box 5 enter $20,800; or box 6 or 7 enter $13,850.
If you are a surviving spouse and your spouse died in 2023, see instructions for amount to enter on line 18............
Arizona taxable income: Subtract line 18 from line 17. If less than zero, enter “0”...............................................................
Tax amount: Multiply line 19 by 2.5% (.025)......................................................................................................................
Dependent Tax Credit. See instruction........................................................................................................................
Family income tax credit (from the worksheet - see instructions)........................................................................................
Balance of tax: Subtract lines 21 and 22 from line 20. If less than zero, enter “0”................................................................
Arizona income tax withheld during 2023.....................................................................................................................
2023 Arizona extension payment (Form 204)..............................................................................................................
Increased Excise Tax Credit (from the worksheet - see instructions)..................................................................................
Property Tax Credit from Form 140PTC.......................................................................................................................
Total payments and refundable credits: Add lines 24 through 27 and enter the total.....................................................
TAX DUE: If line 23 is greater than line 28, subtract line 28 from line 23, and enter amount of tax due. Skip line 30...................
OVERPAYMENT: If line 28 is greater than line 23, subtract line 23 from line 28, and enter the amount of overpayment..............

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17

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24
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28
29
30

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Continued on page 2 

Page 1 of 3

Your Name (as shown on page 1)

Your Social Security Number

00

	 44 Total voluntary gifts: Add lines 32 through 42...................................................................................................................... 44
	 45 REFUND: If line 31 is an overpayment, subtract line 44 from line 31. If less than zero, enter amount owed on line 46........ 45
Direct Deposit of Refund: Check box 45A if your deposit will be ultimately placed in a foreign account; see instructions.	 45A
	
ROUTING NUMBER	
ACCOUNT NUMBER
C		Checking or
98 S		Savings

00
00

Voluntary Gifts

	 31 Enter the amount from page 1, line 29 Tax Due; or line 30 Overpayment....................................................................... 31
Solutions Teams
	 32 - 42 Voluntary Gifts to:
00 Arizona Wildlife................ 33
00
Assigned to Schools............ 32
Child Abuse Prevention............ 34
00 Domestic Violence Services.35
00 Political Gift..................... 36
00
Neighbors Helping Neighbors.. 37
00 Special Olympics................. 38
00 Veterans’ Donations Fund. 39
00
State
I Didn’t Pay Enough Fund........ 40
00 Sustainable
00 Spay/Neuter of Animals... 42
00
Parks and Road Fund......... 41

Refund or
Amount Owed

	 43 Political Party (if amount is entered on line 36 - check only one box):
431Democratic 432Libertarian 433Republican

	 46 AMOUNT OWED: If line 31 is a tax due, add lines 31 and 44. Make check payable to Arizona Department of Revenue;
write your SSN on payment, and include with your return.......................................................................................................... 46

00

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.

	 	

	 	

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PLEASE SIGN HERE

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YOUR SIGNATURE		 DATE		

SPOUSE’S SIGNATURE		 DATE		

	

	 	

OCCUPATION

SPOUSE’S OCCUPATION

	 	

PAID PREPARER’S SIGNATURE		 DATE		 FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED)

	

	 	

PAID 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 your return.
•	 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 10414 (23)	

AZ Form 140A (2023)

Print Form

Page 2 of 3

Your Name (as shown on page 1)

Your Social Security Number

2023 Form 140A Dependent and Other Exemptions Information
•	

Include page 3 with your return if:
•	 You are listing additional dependents (for box 10a and 10b) from page 1.
You are listing additional qualifying parents and grandparents (for box 11a) from page 1.
•	 You are claiming Other Exemptions on page 1, line 15.

Part 1: Dependents (Box 10a and 10b) continued from page 1

Information used to compute your allowable Dependent Tax Credit on page 1, line 21.
NOTE: If you have more than three qualifying dependents, you must complete Part 1 and the worksheet in the instructions to
compute your Dependent Tax Credit on line 21.
(a)
FIRST AND LAST NAME

(Do not list yourself or spouse.)

(b)

(c)

(d)

SOCIAL SECURITY
NUMBER

RELATIONSHIP

NO. OF MONTHS
LIVED IN YOUR HOME
IN 2023

(e)

Dependent Age
included in:

1
(Box 10a )

2
(Box 10b)

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10f
10g
10h
10i
10j
10k
10l
10m
10n
10o
10p

(f)

 IF YOU DID

NOT CLAIM THIS
PERSON ON
YOUR FEDERAL
RETURN DUE TO
EDUCATIONAL
CREDITS

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Part 2: Qualifying parents and grandparents (Box 11a) continued from page 1
Additional qualifying parents and grandparents information used to compute your allowable exemption on page 1, line 16.
(e)
(a)
(b)
(c)
(d)
NO.
OF
MONTHS

IF
AGE 65
FIRST AND LAST NAME
SOCIAL SECURITY
RELATIONSHIP
(Do not list yourself or spouse.)

LIVED IN YOUR HOME
IN 2023

NUMBER

OR OVER

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11e
11f
11g
11h
11i
11j

(f)

 IF DIED IN
2023

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Part 3: Other Exemptions

Information used to compute your allowable Other Exemptions on page 1, line 15.
(c)
(a)
(b)
FIRST AND LAST NAME

(Do not list yourself or spouse.)

SOCIAL SECURITY
NUMBER

AGE 65 OR OVER
(see instructions)

C1

1
2
3
4
5
6
7
8
9
10

(d)

STILLBORN
CHILD IN 2023

C2

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Enter the total number of individuals listed in Part 3 in box 15E on page 1, line 15.
ADOR 10414 (23)	

AZ Form 140A (2023)

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