Donation Form Donor's Name* First Last Social Security NumberLast four onlyTax Filing Status*Married Filing JointlyMarried Filing SeparateSingleUnmarried Head of HouseholdDonor's Spouse First Last Spouse Social Security NumberLast four onlyMailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*The Individual Tax Credit will be claimed in the tax year*2019This donation is*the only donation I/we have made for this tax yearNOT the only donation I/we have made for this tax yearPrior donation informationList the name of School Tuition Organization and the amount contributed for the Private School Tuition Tax Credit Recommendation*I/we would like to make a donation to the General Scholarship fund for any qualified studentI/we would like to recommend a schoolI/we would like to recommend that our donation be considered for an award to a specific student at a specified schoolSchool Recommendation Hand in Hand Christian, Yuma First Christian Preschool, Yuma Freedom Baptist Academy, Yuma Immaculate Coneption School, Yuma Saint Francis of Assisi, Yuma Southwestern Christian School, Yuma The Learning Pad, Yuma Yuma Adventist School Yuma Christian Academy Yuma Lutheran School Yuma Catholic High School Student RecommendationSchool NameStudent Name Use the + button to add additional students to be recommended for a scholarship2019 Single Tax CreditTaxpayers may claim a dollar-for-dollar tax credit up to $1,135 against their Arizona State income tax. If the taxpayer has actual Arizona state income tax less than the allowable credit, the law allows a carryover of any unused donation for up to five years. Amounts contributed up to $569 are considered as Original tax credit, and any amount over will then be considered an Overflow tax credit. 2019 tax deadline is April 15, 2020.Original $569.00Overflow $566.00Combined Maximum Credit $1,135.00Other Amount2019 Married Tax CreditTaxpayers may claim a dollar-for-dollar tax credit up to $2,269 against their Arizona State income tax. If the taxpayer has actual Arizona state income tax less than the allowable credit, the law allows a carryover of any unused donation for up to five years. Amounts contributed up to $1,138 are considered as Original tax credit, and any amount over will then be considered an Overflow tax credit. 2019 tax deadline is April 15, 2020.Original $1,138.00Overflow $1,131.00Combined Maximum Credit $2,269.00Other Amount2019 Tax Credit Enter an amount here if your Arizona income tax is less than the allowable credit amounts.Total 2019 Tax Credit Amount $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name CC Billing Zip Code CAPTCHANotice* I have read the noticeA School Tuition Organization cannot award, restrict, or reserve schoalrships solely on the basis of a donor's recommendation. A taxpayer may not claim a credit if the taxpayer agrees to swap donations with another taxpayer to benefit either taxpayer's own dependent.