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Property Tax Refund (Credit) Claim
ARIZONA FORM
                                                                                                                                                                    2007
      140PTC                               You must file this form, or Form 204, by April 15, 2008.

           Check this box if amended for year 2007
 95
  YOUR FIRST NAME AND INITIAL                                                         LAST NAME                                          YOUR SOCIAL SECURITY NO. (required)
    1
  IF A JOINT CLAIM, SPOUSE’S FIRST NAME AND INITIAL                                   LAST NAME                                          SPOUSE’S SOCIAL SECURITY NO. (required)
    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                                                                                                                                              Filing under extension
                                                                                       94                                                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, 2007, 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 2007? 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 2007? 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 2007? Enter your birth date in
    box 79 above .......................................................................... 8
  9 Did you receive Title 16, SSI payments in 2007? 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 2007. Attach evidence of
                                                                                                                                                                               00
    property taxes paid during 2007 ......................................................................................................................   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 2007. 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 2007, 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 (07)
YOUR NAME AS SHOWN ON PAGE 1                                                                                               YOUR SOCIAL SECURITY NO.


                                                                                                                 (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 2007............................ A
B               Dividend and interest income received in 2007 ....................... 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.
                                2007 Schedule I                                      2007 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 2007 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 2007
    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
 PLEASE SIGN HERE




                       belief, they are true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which
                       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
                                                                                      AZ Form 140PTC (2007)
ADOR 91-5373 (07)                                                                                                                                                             Page 2 of 2

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azdor.gov Forms 140PTC_F

  • 1. Property Tax Refund (Credit) Claim ARIZONA FORM 2007 140PTC You must file this form, or Form 204, by April 15, 2008. Check this box if amended for year 2007 95 YOUR FIRST NAME AND INITIAL LAST NAME YOUR SOCIAL SECURITY NO. (required) 1 IF A JOINT CLAIM, SPOUSE’S FIRST NAME AND INITIAL LAST NAME SPOUSE’S SOCIAL SECURITY NO. (required) 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 Filing under extension 94 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, 2007, 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 2007? 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 2007? 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 2007? Enter your birth date in box 79 above .......................................................................... 8 9 Did you receive Title 16, SSI payments in 2007? 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 2007. Attach evidence of 00 property taxes paid during 2007 ...................................................................................................................... 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 2007. 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 2007, 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 (07)
  • 2. YOUR NAME AS SHOWN ON PAGE 1 YOUR SOCIAL SECURITY NO. (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 2007............................ A B Dividend and interest income received in 2007 ....................... 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. 2007 Schedule I 2007 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 2007 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 2007 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 PLEASE SIGN HERE belief, they are true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which 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 AZ Form 140PTC (2007) ADOR 91-5373 (07) Page 2 of 2