Arizona Form 5011 Certificate To Establish Residency In Another U S State Pursuant To A R S 42-5009(-2025

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Who must use Arizona Form 140NR? File a Form 140NR if you were not an Arizona resident but earned income from an Arizona source in 2021. This Booklet Contains: Form 140NR Nonresident Personal Income Tax.
The form is an agreement between the seller and the purchaser. Do not send any copies of this form to the Arizona Department of Revenue; the purchaser and seller keeps the form for records. Form 5011 is a questionnaire for the seller to determine if the purchaser qualifies as an out-of-state resident.
Nonresidents are subject to Arizona tax on any income earned from Arizona sources. Nonresidents may also exclude income Arizona law does not tax. Individuals subject to tax by both Arizona and another state on the same income may also be eligible for a tax credit.
As of the 2023 filing season, Arizona has a flat income tax rate of 2.5 percent, replacing its graduated rate structure. This means that every Arizona taxpayer, regardless of income level, will pay the same 2.5 percent rate.
Include the payment with Form 140NR. If you are expecting a refund or owe no tax, or owe tax but are not sending a payment, mail to Arizona Department of Revenue, PO Box 52138, Phoenix, AZ 85072-2138.
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