Your Name (as shown on page 1)
Your Social Security Number
Subtotal Itemized Deductions
23 Tentative Arizona itemized deduction: Add lines 1, 2, 3, 4, 9, and 22, and enter the total on line 23.
Complete lines 24 through 28 below if your federal adjusted gross income is:
• more than $309,900 (married taxpayers filing a joint return or surviving spouse), or
• $284,050 (head of household), or
• $258,250 (unmarried individual who is not a surviving spouse or head of household), or
• $154,950 (married filing a separate return)
00
Otherwise, skip lines 24 through 28 ........................................................................................... 23
24 Enter on line 24 the amount by which you have to reduce your federal itemized deductions
because your federal adjusted gross income was over this threshold if your federal adjusted
gross income is:
• more than $309,900 (married taxpayers filing a joint return or surviving spouse), or
• $284,050 (head of household), or
• $258,250 (unmarried individual who is not a surviving spouse or head of household) or
00
• $154,950 (married filing a separate return) ........................................................................... 24
25 Enter your total federal itemized deductions allowable on federal Form 1040, Schedule A,
00
prior to the federal adjusted gross income limitation ................................................................... 25
26 Divide line 23 by line 25, and enter the ratio ............................................................................... 26
00
27 Multiply line 24 by the ratio on line 26, and enter the result ........................................................ 27
00
28 Subtract line 27 from line 23. Enter the result here ........................................................................................................... 28
Part 2
Portion of Itemized Deductions Allowable for the Part of the Year While a Nonresident
Adjustment to Medical and Dental Expenses
00
29 Medical and dental expenses ...................................................................................................... 29
30 Amount of distributions used to pay qualified medical expenses from your
00
Arizona Long-Term Health Care Savings Account (AZLTHSA) included on line 29 .................... 30
00
31 Medical expenses allowed to be taken as a federal itemized deduction ..................................... 31
00
32 Add lines 30 and 31, and enter the total ...................................................................................... 32
00
33 If line 29 is the same as or more than line 32, subtract line 32 from line 29. Otherwise, go to line 34 .............................. 33
00
34 If line 32 is more than line 29, subtract line 29 from line 32 ............................................................................................... 34
Adjustment to Interest Deduction
35 If you received a federal credit for interest paid on mortgage credit certificates (from federal Form 8396), enter the
00
amount of mortgage interest you paid for 2015 that is equal to the amount of your 2015 federal credit ........................... 35
Adjustment to Gambling Losses
00
36 Wagering losses allowed as a federal itemized deduction .......................................................... 36
00
37 Total gambling winnings included in your federal adjusted gross income ................................... 37
00
38 Arizona lottery subtraction from Form 140PY, page 2, line 44 .................................................... 38
00
39 Maximum allowable gambling loss deduction: Subtract line 38 from line 37.............................. 39
00
40 If line 39 is less than line 36, subtract line 39 from line 36; otherwise enter “zero” ............................................................ 40
Adjustment to Charitable Contributions
00
41 Amount of charitable contributions for which you are taking a credit under Arizona law .................................................... 41
Adjusted Itemized Deductions
00
42 Add the amounts on lines 33 and 35 ........................................................................................... 42
00
43 Add lines 34, 40 and 41 ............................................................................................................... 43
00
44 Total itemized deductions allowed to be taken on federal return ................................................. 44
00
45 Enter the amount from line 42 above .......................................................................................... 45
00
46 Add the amount on lines 44 and 45 ............................................................................................. 46
00
47 Enter the amount from line 43 above .......................................................................................... 47
00
48 Subtract line 47 from line 46 ........................................................................................................ 48
49 If you skipped lines 24 through 28, enter the amount on line 23 here. If you completed lines
00
24 through 28, enter the amount from line 28 here. .................................................................... 49
00
50 Subtract line 49 from line 48 ........................................................................................................ 50
51 Arizona income ratio from line 4 of the worksheet on page 3 of Schedule A(PYN) instructions . 51
00
52 Multiply the ratio on line 51 by the amount on line 50 ................................................................. 52
00
53 Add lines 49 and 52. Enter the total here and on Form 140PY, page 2, line 55 ................................................................ 53
AZ Schedule A(PYN) (2015)
ADOR 10176 (15)
Page 2 of 2
Print Form