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Property Tax Refund (Credit) Claim
ARIZONA FORM
                                                                                                                                                                    2006
      140PTC                               You must file this form, or Form 204, by April 16, 2007.

          Check this box if amended for year 2006
 95
  YOUR FIRST NAME AND INITIAL                                                         LAST NAME                                              YOUR SOCIAL SECURITY NO.
    1
  IF A JOINT CLAIM, SPOUSE’S FIRST NAME AND INITIAL                                   LAST NAME                                              SPOUSE’S SOCIAL SECURITY NO.
    1
  PRESENT HOME ADDRESS - NUMBER AND STREET, RURAL ROUTE                    APT. NO. DAYTIME PHONE (with area code)                           YOUR DATE OF BIRTH
    2                                                                                                                                        79    MMD D Y Y Y Y
  HOME ADDRESS CONTINUED                                                              HOME PHONE (with area code)                            Check this box if:
    2                                                                                  94                                                              Filing under extension
                                                                                                                                             82F
  CITY, TOWN OR POST OFFICE                              STATE               ZIP CODE                                                 FOR DOR USE ONLY
    3
Qualifications for Credit (Check the boxes that apply):
  4 On December 31, 2006, were you renting or did you own?                                         Rent Own
    If you own a mobile home but rent the space, check “Rent” .. 4
                                                                                                   Yes No 88
  5 Were you an Arizona resident for all of 2006? If “No”,
    STOP. You do not qualify ...................................................... 5
  6 Did you pay property taxes on your home, pay rent, or pay a
                                                                                                                      81                            80
    combination of both in 2006? See instructions for
    qualifications. If “No”, STOP. You do not qualify .................. 6
  7 Is this the only Property Tax Refund being claimed in your
    household? If “No”, STOP. You do not qualify....................... 7
  8 Were you age 65 or older in 2006? Enter your birth date in
    box 79 above .......................................................................... 8
  9 Did you receive Title 16, SSI payments in 2006? If “Yes”,
    attach proof. If you answered “No” to both 8 and 9,
    STOP. You do not qualify. ..................................................... 9
Income
                                                                                                                                                                            00
 10 TOTAL HOUSEHOLD INCOME: Enter the amount from page 2, Part I, line J, column 4..................................                                         10
Credit
 11 a If you lived alone, enter the amount of credit from page 2, Part I, Schedule I, and
        check the box ................................................................................................................. 11a Schedule I
    b If you lived with your spouse or one or more other persons, enter the amount of
                                                                                                                                                                            00
        credit from page 2, Part I, Schedule II, and check the box ............................................. 11b                        Schedule II .    11
 12 If you owned your property, enter property taxes actually paid during 2006. Attach evidence of
                                                                                                                                                                            00
    property taxes paid during 2006 ......................................................................................................................   12
                                                                                                                                                                            00
 13 If you rented, enter property taxes paid by your landlord on your portion of rents. Attach Form 201 ................                                     13
                                                                                                                                                                            00
 14 Total property taxes paid in 2006. Add lines 12 and 13 .....................................................................................             14
                                                                                                                                                                            00
 15 Amount of Property Tax Credit: Enter the amount from line 11 or line 14, whichever is less .........................                                     15
 16 If you have been claimed as a dependent on anyone else’s tax return, complete the following:
    Name of taxpayer who claimed you:                                                                    Social Security No.:

   Address:
   If you are not claimed as a dependent on anyone else’s tax return, turn the form over and complete Part II.
   If someone else claims you as a dependent, skip lines 17 and 18, and complete line 19.
                                                                                                                                                                            00
17 Credit for increased excise taxes from Form 140PTC, page 2, Part II, line 6 .................................................. 17
18 Enter the number from page 2, Part II, line 2, here ............................................................. 18
19 Total Credit: Add lines 15 and 17, and enter the total. See page 5 of the instructions if you have to file
                                                                                                                                                                            00
   Arizona Form 140 or Form 140A ......................................................................................................................... 19
              Direct Deposit of Refund: See page 5 of instructions.
                                                                                 =
              ROUTING NUMBER                             ACCOUNT NUMBER

                                                                                 =2. If this is                                C       Checking or
        98                                                                                                                     S       Savings
If this is your first claim for 2006, STOP HERE AND GO TO THE SIGNATURE BOX ON PAGE
an amended claim, complete lines 20 through 22, and check the box at the top of the form.
AMENDED
                                                                                                                                                           00
20 Enter the amount from line 5 of the worksheet on page 6 of the instructions ..................................................... 20
                                                                                                                                                           00
21 Additional refund: If line 19 is larger than line 20, subtract line 20 from line 19 ................................................. 21
22 Amount to pay: If line 19 is less than line 20, subtract line 19 from line 20. Make check payable to
                                                                                                                                                           00
    Arizona Department of Revenue; include SSN on payment ............................................................................... 22
                                                                                                                                       Continued on page 2
ADOR 91-5373 (06)
Form 140PTC (2006)                                                                                                                                                                  Page 2 of 2
                                                                                                                           (1)                (2)                 (3)                  (4)
                                                                                                                         YOU           YOUR SPOUSE OTHER PERSONS TOTAL (1+2+3)
Part I Schedule of Household Income
A               Salaries, wages, tips, etc., received in 2006............................                      A
B               Dividend and interest income received in 2006 .......................                          B
C               Business and farm income ......................................................                C
D               Gain or loss from sale or exchange of property .......................                         D
E               Pension and annuity income. Include Arizona state and local
                retirement benefits, civil service, and military retirement. Do
                not include social security or railroad retirement benefits ........                            E
F               Rent and royalty income ..........................................................             F
G               Partnership, estate, and trust income ......................................                   G
H               Alimony ....................................................................................   H
 I              Other Income: Specify source on separate sheet...................                               I
J               Total household income: Add lines A through I in column 4.
                Enter here and on the front of this form, line 10 ......................                       J

                      Use the amount on line J, column 4, to compute your credit from the proper schedule below.

                                            2006 Schedule I                                                                                 2006 Schedule II
                                      If you live alone, use this Schedule.                                              If you live with your spouse or another person, use this Schedule.
                     Household                  Tax                  Household                     Tax                  Household               Tax             Household                Tax
                      Income                   Credit                 Income                      Credit                 Income                Credit            Income                 Credit
           $            0 - 1,750               $502           $ 2,751 - 2,850                     $256             $       0 - 2,500           $502        $ 4,001 - 4,150             $256
                    1,751 - 1,850                479             2,851 - 2,950                      234                 2,501 - 2,650            479          4,151 - 4,300              234
                    1,851 - 1,950                457             2,951 - 3,050                      212                 2,651 - 2,800            457          4,301 - 4,450              212
                    1,951 - 2,050                435             3,051 - 3,150                      189                 2,801 - 2,950            435          4,451 - 4,600              189
                    2,051 - 2,150                412             3,151 - 3,250                      167                 2,951 - 3,100            412          4,601 - 4,750              167

                    2,151 - 2,250                 390              3,251 - 3,350                     145                3,101 - 3,250               390        4,751 - 4,900                 145
                    2,251 - 2,350                 368              3,351 - 3,450                     123                3,251 - 3,400               368        4,901 - 5,050                 123
                    2,351 - 2,450                 345              3,451 - 3,550                     100                3,401 - 3,550               345        5,051 - 5,200                 100
                    2,451 - 2,550                 323              3,551 - 3,650                      78                3,551 - 3,700               323        5,201 - 5,350                  78
                    2,551 - 2,650                 301              3,651 - 3,750                      56                3,701 - 3,850               301        5,351 - 5,500                  56
                    2,651 - 2,750                 279              3,751 and up                        0                3,851 - 4,000               279        5,501 and up                    0
                                                      Enter the amount of credit on the front of this form, line 11.
Part II Credit for Increased Excise Taxes
Do not complete Part II if you completed line 16 on page 1 of Form 140PTC. Do not complete Part II if you were sentenced for at least
60 days of 2006 to a county, state, or federal prison.
    1 List dependents. See page 5 of the instructions.
                                                                                                                                    NO. OF MONTHS LIVED
          FIRST AND LAST NAME                            SOCIAL SECURITY NO.                     RELATIONSHIP                       IN YOUR HOME IN 2006
     1a
     1b
     1c
    2 Enter total number of dependents listed on lines 1a through 1c ..............................................................       2
    3 If you are married filing a joint claim, enter the number “2” here. Otherwise, enter the number “1”........                          3
    4 Add the amount on line 2 and line 3, and enter the total .........................................................................  4
                                                                                                                                                       00
    5 Multiply the amount on line 4 by $25, and enter the result.......................................................................   5
                                                                                                                                                       00
    6 Enter the smaller of line 5 or $100. Also, enter this amount on Form 140PTC, page 1, line 17. ............                          6

                       I have read this claim and any attachments with it. Under penalties of perjury, I declare that 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
 PLEASE SIGN HERE




                       preparer has any knowledge.

                       YOUR SIGNATURE                                                                               DATE                 OCCUPATION


                       SPOUSE’S SIGNATURE                                                                           DATE                 SPOUSE’S OCCUPATION


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


                       PAID PREPARER’S TIN                                DATE                            PAID PREPARER’S ADDRESS
                                                        Mail to Arizona Department of Revenue, PO Box 52138, Phoenix, AZ, 85072-2138
ADOR 91-5373 (06)

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azdor.gov Forms 140PTC

  • 1. Property Tax Refund (Credit) Claim ARIZONA FORM 2006 140PTC You must file this form, or Form 204, by April 16, 2007. Check this box if amended for year 2006 95 YOUR FIRST NAME AND INITIAL LAST NAME YOUR SOCIAL SECURITY NO. 1 IF A JOINT CLAIM, SPOUSE’S FIRST NAME AND INITIAL LAST NAME SPOUSE’S SOCIAL SECURITY NO. 1 PRESENT HOME ADDRESS - NUMBER AND STREET, RURAL ROUTE APT. NO. DAYTIME PHONE (with area code) YOUR DATE OF BIRTH 2 79 MMD D Y Y Y Y HOME ADDRESS CONTINUED HOME PHONE (with area code) Check this box if: 2 94 Filing under extension 82F CITY, TOWN OR POST OFFICE STATE ZIP CODE FOR DOR USE ONLY 3 Qualifications for Credit (Check the boxes that apply): 4 On December 31, 2006, were you renting or did you own? Rent Own If you own a mobile home but rent the space, check “Rent” .. 4 Yes No 88 5 Were you an Arizona resident for all of 2006? If “No”, STOP. You do not qualify ...................................................... 5 6 Did you pay property taxes on your home, pay rent, or pay a 81 80 combination of both in 2006? See instructions for qualifications. If “No”, STOP. You do not qualify .................. 6 7 Is this the only Property Tax Refund being claimed in your household? If “No”, STOP. You do not qualify....................... 7 8 Were you age 65 or older in 2006? Enter your birth date in box 79 above .......................................................................... 8 9 Did you receive Title 16, SSI payments in 2006? If “Yes”, attach proof. If you answered “No” to both 8 and 9, STOP. You do not qualify. ..................................................... 9 Income 00 10 TOTAL HOUSEHOLD INCOME: Enter the amount from page 2, Part I, line J, column 4.................................. 10 Credit 11 a If you lived alone, enter the amount of credit from page 2, Part I, Schedule I, and check the box ................................................................................................................. 11a Schedule I b If you lived with your spouse or one or more other persons, enter the amount of 00 credit from page 2, Part I, Schedule II, and check the box ............................................. 11b Schedule II . 11 12 If you owned your property, enter property taxes actually paid during 2006. Attach evidence of 00 property taxes paid during 2006 ...................................................................................................................... 12 00 13 If you rented, enter property taxes paid by your landlord on your portion of rents. Attach Form 201 ................ 13 00 14 Total property taxes paid in 2006. Add lines 12 and 13 ..................................................................................... 14 00 15 Amount of Property Tax Credit: Enter the amount from line 11 or line 14, whichever is less ......................... 15 16 If you have been claimed as a dependent on anyone else’s tax return, complete the following: Name of taxpayer who claimed you: Social Security No.: Address: If you are not claimed as a dependent on anyone else’s tax return, turn the form over and complete Part II. If someone else claims you as a dependent, skip lines 17 and 18, and complete line 19. 00 17 Credit for increased excise taxes from Form 140PTC, page 2, Part II, line 6 .................................................. 17 18 Enter the number from page 2, Part II, line 2, here ............................................................. 18 19 Total Credit: Add lines 15 and 17, and enter the total. See page 5 of the instructions if you have to file 00 Arizona Form 140 or Form 140A ......................................................................................................................... 19 Direct Deposit of Refund: See page 5 of instructions. = ROUTING NUMBER ACCOUNT NUMBER =2. If this is C Checking or 98 S Savings If this is your first claim for 2006, STOP HERE AND GO TO THE SIGNATURE BOX ON PAGE an amended claim, complete lines 20 through 22, and check the box at the top of the form. AMENDED 00 20 Enter the amount from line 5 of the worksheet on page 6 of the instructions ..................................................... 20 00 21 Additional refund: If line 19 is larger than line 20, subtract line 20 from line 19 ................................................. 21 22 Amount to pay: If line 19 is less than line 20, subtract line 19 from line 20. Make check payable to 00 Arizona Department of Revenue; include SSN on payment ............................................................................... 22 Continued on page 2 ADOR 91-5373 (06)
  • 2. Form 140PTC (2006) Page 2 of 2 (1) (2) (3) (4) YOU YOUR SPOUSE OTHER PERSONS TOTAL (1+2+3) Part I Schedule of Household Income A Salaries, wages, tips, etc., received in 2006............................ A B Dividend and interest income received in 2006 ....................... B C Business and farm income ...................................................... C D Gain or loss from sale or exchange of property ....................... D E Pension and annuity income. Include Arizona state and local retirement benefits, civil service, and military retirement. Do not include social security or railroad retirement benefits ........ E F Rent and royalty income .......................................................... F G Partnership, estate, and trust income ...................................... G H Alimony .................................................................................... H I Other Income: Specify source on separate sheet................... I J Total household income: Add lines A through I in column 4. Enter here and on the front of this form, line 10 ...................... J Use the amount on line J, column 4, to compute your credit from the proper schedule below. 2006 Schedule I 2006 Schedule II If you live alone, use this Schedule. If you live with your spouse or another person, use this Schedule. Household Tax Household Tax Household Tax Household Tax Income Credit Income Credit Income Credit Income Credit $ 0 - 1,750 $502 $ 2,751 - 2,850 $256 $ 0 - 2,500 $502 $ 4,001 - 4,150 $256 1,751 - 1,850 479 2,851 - 2,950 234 2,501 - 2,650 479 4,151 - 4,300 234 1,851 - 1,950 457 2,951 - 3,050 212 2,651 - 2,800 457 4,301 - 4,450 212 1,951 - 2,050 435 3,051 - 3,150 189 2,801 - 2,950 435 4,451 - 4,600 189 2,051 - 2,150 412 3,151 - 3,250 167 2,951 - 3,100 412 4,601 - 4,750 167 2,151 - 2,250 390 3,251 - 3,350 145 3,101 - 3,250 390 4,751 - 4,900 145 2,251 - 2,350 368 3,351 - 3,450 123 3,251 - 3,400 368 4,901 - 5,050 123 2,351 - 2,450 345 3,451 - 3,550 100 3,401 - 3,550 345 5,051 - 5,200 100 2,451 - 2,550 323 3,551 - 3,650 78 3,551 - 3,700 323 5,201 - 5,350 78 2,551 - 2,650 301 3,651 - 3,750 56 3,701 - 3,850 301 5,351 - 5,500 56 2,651 - 2,750 279 3,751 and up 0 3,851 - 4,000 279 5,501 and up 0 Enter the amount of credit on the front of this form, line 11. Part II Credit for Increased Excise Taxes Do not complete Part II if you completed line 16 on page 1 of Form 140PTC. Do not complete Part II if you were sentenced for at least 60 days of 2006 to a county, state, or federal prison. 1 List dependents. See page 5 of the instructions. NO. OF MONTHS LIVED FIRST AND LAST NAME SOCIAL SECURITY NO. RELATIONSHIP IN YOUR HOME IN 2006 1a 1b 1c 2 Enter total number of dependents listed on lines 1a through 1c .............................................................. 2 3 If you are married filing a joint claim, enter the number “2” here. Otherwise, enter the number “1”........ 3 4 Add the amount on line 2 and line 3, and enter the total ......................................................................... 4 00 5 Multiply the amount on line 4 by $25, and enter the result....................................................................... 5 00 6 Enter the smaller of line 5 or $100. Also, enter this amount on Form 140PTC, page 1, line 17. ............ 6 I have read this claim and any attachments with it. Under penalties of perjury, I declare that 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 PLEASE SIGN HERE preparer has any knowledge. YOUR SIGNATURE DATE OCCUPATION SPOUSE’S SIGNATURE DATE SPOUSE’S OCCUPATION PAID PREPARER’S SIGNATURE FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED) PAID PREPARER’S TIN DATE PAID PREPARER’S ADDRESS Mail to Arizona Department of Revenue, PO Box 52138, Phoenix, AZ, 85072-2138 ADOR 91-5373 (06)