The following information is required by the State of Arizona. Please print and fill out the form completely.
I am donating:
$________to the Original Tax Credit (Up to $1110 for Married Filing Jointly)
$________to the Switcher Tax Credit (Up to $1103 Married Filing Jointly) (You can donate here only after you have donated $1110 to the Original above.)
$________to the Original Tax Credit (Up to $555 Single/Head of Household)
$________to the Switcher Tax Credit (Up to $552 Single/Head of Household) (You can donate here only after you have donated $555 to the Original credit.)
Recommended School or Student________________________________________________________
Mail this form with your donation & check payable to: NACSSF, P O Box 3923, Cottonwood, AZ 86326
Check #_______________________________Please no staples or tape.
Visa Master Card ___________________________________________ _____/______
Card number Expires
Billing Address (if different)_________________________________________________________________________________________
Donation is to be claimed for tax year: ___ 2018 ___2019
Filing status on my income tax return:
___Single, Married Filing Separate, or Head of Household
___ Married Filing Jointly
Have you already donated to another school tuition organization: ____Yes ____No
If yes which STO?__________________________________________________________________________________________________
And how much?____________________________________________________________________________________________________
Thank you for your donation!