Arizona Form 120s - Arizona S Corporation Income Tax Return - 2004 Page 2

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AZ Form 120S (2004) Page 2

Schedule A - Other Information

A1 Date business began in Arizona or date income was ﬁ rst derived from Arizona sources

A2 Address at which tax records are located for audit purposes:

_____________________________________________________________________________________________________________________

A3 The taxpayer designates the individual listed below as the person to contact to schedule an audit of this return and authorizes

the disclosure of conﬁ dential information to this individual. (See instructions page 8)

Name and title ____________________________________________________________ Phone # _____________________________________

A4 List prior taxable years for which a federal examination has been ﬁ nalized __________________________________________________________

_____________________________________________________________________________________________________________________

NOTE: ARS § 43-327 requires the taxpayer, within ninety days after ﬁ nal determination, to report these changes under separate

cover to the Arizona Department of Revenue or to ﬁ le amended returns reporting these changes. (See instructions page 1)

A5 Amount of net income subject to Arizona corporate income tax for prior taxable year (2003 Form 120S, line 11) _____________________________

A6 Indicate tax accounting method:

Cash

Accrual

Other

(Specify method) ________________________________________

Schedule B - Apportionment Formula (Multistate S Corporations Only)

See instruction pages 8, 9 and 10

NOTE: Qualifying air carriers must use Schedule ACA

B1 Property Factor

Column A

Column B

Column C

Value of real and tangible personal property (by averaging the value of

Total

Total Within

Ratio Within

owned property used at the beginning and end of the tax period; rented

Within

and

Arizona

property at capitalized value)

A ÷ B

Arizona

Without Arizona

a. Owned property (at original cost):

Inventories ............................................................................................

Depreciable assets ...............................................................................

Land......................................................................................................

Other assets - (describe) ___________________________________

Minus: Construction in progress (if included in above totals) ...............

(

)

(

)

Minus: Nonbusiness property (if included in above totals) ...................

(

)

(

)

Total of section a...................................................................................

b. Rented property (capitalize at 8 times net rental paid) .........................

•

c. Total owned and rented property (section a total plus section b)..........

B2 Payroll Factor

Total wages, salaries, commissions and other compensation to employees

•

(per federal Form 1120S or payroll reports) .................................................

B3 Sales Factor

a. Sales delivered or shipped to Arizona purchasers................................

b. Other gross receipts .............................................................................

c. Total sales and other gross receipts .....................................................

d. Double weight Arizona sales and gross receipts ..................................

X 2

e. Sales factor (for column A - multiply item c by item d; for column B -

•

enter amount from item c).....................................................................

•

B4 Total ratio - add B1(c), B2 and B3(e) in column C..........................................................................................................................

•

B5 Average apportionment ratio - divide B4 by four (4). Enter the result in column C and on page 1, line 7....................................

Schedule C - Shareholder Information

Prepare a schedule that lists each shareholder’s name, address, TIN, and pro rata share of income or loss.

Label the listing as “Schedule C - Shareholder Information” and attach the schedule immediately after page 2 of the Form 120S.

Certiﬁ cation

The following certiﬁ cation must be signed by one or more of the following ofﬁ cers (president, treasurer, or any other principal ofﬁ cer).

Under penalties of perjury, I (we), the undersigned ofﬁ cer(s) authorized to sign this return, declare that I (we) have examined this return, including the

accompanying schedules and statements, and to the best of my (our) knowledge and belief, it is a true, correct and complete return, made in good faith, for

the taxable year stated pursuant to the income tax laws of the State of Arizona.

___________________________________________________________________________________________________________________________________

Ofﬁ cer’s signature

Title

Date

Please

Sign

___________________________________________________________________________________________________________________________________

Ofﬁ cer’s signature

Title

Date

Here