This document is an Arizona state resident personal income tax return form for the year 2001. It contains instructions for filling out boxes with personal information like name, address, social security number, as well as financial information like federal adjusted gross income, standard deduction, taxable income, tax amount, payments made, refund or amount owed. The form has boxes to fill out calculations for the tax return and requires signatures for certification.

1. Resident Personal Income Tax Return (EZ Form)
ARIZONA FORM
2001
140EZ USE BLACK OR BLUE INK ONLY.
1 Your first name and initial Last name Your Social Security Number
M
Spouse’s first name and initial Last name Spouse’s Social Security Number
IMPORTANT
! !
2 Present home address - number and street, rural route, apt. no.
You must enter your SSNs.
FOR DOR USE ONLY
3 City, town or post office State Zip Code + 4
Daytime phone with area code 94 Home phone with area code
88
81 80
Filing Status
82 Fill in one oval if filing under an extension:
Fill in ovals completely. Example: Fill in one oval.
4 month extension 82D
4 Married filing a joint return
6 month extension 82F
5 Single
, .00
6 Federal adjusted gross income from your federal return.................................................................................................... 6
7 Standard deduction and personal exemption. If you checked filing status box 4, enter $12,300; if you checked
, .00
filing status box 5, enter $6,150 ......................................................................................................................................... 7
, .00
8 Arizona taxable income: Subtract line 7 from line 6 .......................................................................................................... 8
Enclose but do not attach payments.
, .00
9 Amount of tax from Optional Tax Rate Tables .................................................................................................................... 9
.00
10 Clean Elections Fund Tax Reduction. See instructions, page 4. YOURSELF SPOUSE ....... 11
101 102
, .00
12 Reduced tax: Subtract line 11 from line 9.......................................................................................................................... 12
.00
13 Family income tax credit from worksheet on page 4 of the instructions............................................................................. 13
, .00
14 Subtract line 13 from line 12. If less than zero, enter “0”................................................................................................... 14
, .00
Attach W-2 to back of last page of the return.
15 Clean Elections Fund Tax Credit from worksheet on page 4 of the instructions ................................................................ 15
, .00
16 Balance of tax: Subtract line 15 from line 14. If line 15 is more than line 14, enter “0” .................................................... 16
, .00
17 Arizona income tax withheld during 2001........................................................................................................................... 17
, .00
18 Amount paid with 2001 extension request (Form 204)....................................................................................................... 18
.00
19 Credit for increased excise taxes from worksheet on page 5 of the instructions ............................................................... 19
, .00
20 Total payments: Add lines 17 through 19 .......................................................................................................................... 20
, .00
21 OVERPAYMENT: If line 20 is larger than line 16, subtract line 16 from line 20 ............................................................... 21
22 VOLUNTARY CONTRIBUTION TO THE CITIZENS CLEAN ELECTIONS FUND: See page 5 of
, .00
instructions. If making a contribution, fill in this oval 22A1 and enter the amount........ 22
, .00
23 REFUND: Subtract line 22 from line 21. If less than zero, enter the amount owed on line 24......................................... 23
, .00
24 AMOUNT OWED: If line 16 is larger than line 20, subtract line 20 from line 16, and enter the amount owed ................. 24
Make check payable to Arizona Department of Revenue; include SSN on payment.
ADOR 91-5325 (01) slw