140X Individual Amended Income Tax Return 2017

Arizona Form 140X Individual Amended Income Tax Return FOR CALENDAR YEAR 2017

Your Name (as shown on page 1):

Your Social Security Number:

Spouse’s First Name and Middle Initial: Last Name:

Spouse’s Social Security No.:

Current Home Address: Apt. No.:

City, Town or Post Office: State: ZIP Code: Daytime Phone:

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

Filing Status and Residency

4 Married filing joint return    4a Injured Spouse Protection of Joint Overpayment

5 Head of household: Enter name of qualifying child or dependent on next line:

6 Married filing separate return: Enter spouse’s name and SSN above.

7 Single

8 Resident

9a Nonresident    9b Composite

10 Nonresident active military

11 Part-year resident

12 Part-year resident active military

13 Age 65 or over:

14 Blind:

15 Dependents:

16 Qualifying parents or grandparents:

Income, Deductions, and Credits

17 Federal adjusted gross income:

18 Arizona gross income:

18a Arizona income ratio:

19 Additions to income:

20 Subtotal:

21 Subtractions from income:

22 Total net capital gain or (loss):

23 Total net short-term capital gain or (loss):

24 Total net long-term capital gain or (loss):

25 Net long-term capital gain from assets acquired after December 31, 2011:

26 Multiply line 25 by 25% and enter the result:

27 Net capital gain derived from investment in qualified small business:

28 Reserved

29 Contributions to 529 College Savings Plans:

30 Arizona adjusted gross income:

31 Deductions: Amount:

32 Personal exemptions:

33 Arizona taxable income:

34 Tax from tax table:

35 Tax from recapture of credits:

36 Subtotal of tax:

37 Family income tax credit:

38 Credits from Form 301, Part 2:

39 Balance of tax:

40 Withholding, Estimated, and Extension Payments: Claim of Right:

41 Increased Excise Tax Credit:

42 Property Tax Credit:

43 Other refundable credits: 308-I 342 349 Total:

44 Payment with original return plus all payments after it was filed:

45 Total payments and refundable credits:

46 Overpayment from original return or as later adjusted:

47 Balance of credits:

48 Overpayment:

49 Amount applied to 2018 estimated tax:

50 Refund:

51 Amount owed:

52 Net operating loss year: Year incurred:

Direct Deposit of Refund

Checking Savings

Foreign account? Routing Number: Account Number:

Part 1: Dependent Exemptions

15a First and last name: SSN: Relationship: Months lived in home: Did not qualify on federal return: Not claimed for educational credits:

15b First and last name: SSN: Relationship: Months lived in home: Did not qualify on federal return: Not claimed for educational credits:

15c First and last name: SSN: Relationship: Months lived in home: Did not qualify on federal return: Not claimed for educational credits:

16a First and last name: SSN: Relationship: Months lived in home: Age 65 or over: Died in 2017:

16b First and last name: SSN: Relationship: Months lived in home: Age 65 or over: Died in 2017:

Income, Deductions, Credits You Are Changing

53a Original amount reported: Amount to add or subtract: Corrected amount:

53b Original amount reported: Amount to add or subtract: Corrected amount:

53c Original amount reported: Amount to add or subtract: Corrected amount:

Net Capital Gain or (Loss)

54a Item: Original amount: Amount to add or subtract: Corrected amount:

54b Item: Original amount: Amount to add or subtract: Corrected amount:

54c Item: Original amount: Amount to add or subtract: Corrected amount:

54d Item: Original amount: Amount to add or subtract: Corrected amount:

54e Item: Original amount: Amount to add or subtract: Corrected amount:

Reason for the Change

Address Update

56a Name:

56b Number and Street, R.R., Apt. No.:

56c City, Town or Post Office: State: ZIP Code:

Please Sign Here

Continuation Sheet - Page 3

Dependent Information - Continuation Sheet from Page 2, Part 1

Your Name: Your Social Security Number:

15d SSN: Relationship: Months:

15e SSN: Relationship: Months:

16c SSN: Relationship: Months: