Tax Credit Participation Form - Lake Havasu Unified School District

Lake Havasu Unified School District Tax Credit Extracurricular Activities and Sports OFFICIAL USE ONLY Receipt #:___________ Check #:____________ Ck amt: $___________ Cash: $_____________ Credit card: $________ Last 4 of CC _________ Initialed: __________ Every dollar of State income tax paid through the Extracurricular Activity Fee School Tax Credit program is kept in Havasu and used directly for students by the schools to participate in activities and sports—that’s dollar-­‐for-­‐dollar off your Arizona State income tax liability-­‐ up to $200 per single and $400 for joint filers. You don’t have to have children in the school district to participate. Tax Credit dollars support school activities and enable all students to develop life-­‐long skills and values by participating in clubs, activities, and sports. Deadline to participate is December 31 stPrint name (one name only) __________________________________________ Date _______________ Address _____________________________ City ______________________ State____ Zip ___________ Home phone ____________________________ Work phone __________________________________ Specify amount for tax credit $__________ Maximum $200 (AZ income tax filing: Single or Widowed) $__________ Maximum $400 (AZ income tax filing: Married filing jointly) This payment is eligible for Arizona State income tax credit as allowed by A.R.S. §43-­‐1089.01 Select School preference ___ Lake Havasu High School ___ Smoketree Elementary ___ Havasupai Elementary ___ HS Round Table program ___ Oro Grande Elementary ___ Starline Elementary ___ Thunderbolt Middle School ___ Nautilus Elementary ___ Jamaica Elementary Select activity preference ___ Preference, if any _____________________________________ (Only an activity on the Approved Preference List can be chosen. www.havasu.k12.az.us/business/tax_credit/forms.htm) ___ Optional for HS & MS only: utilize my tax credit for the participation fee for the benefit of a student in need ___ No preference (distributed based on program needs) ____ Kindergarten Enrichment-­‐an extension of the State’s half-­‐day education program. If designating funds for a specific middle or high school student(s), complete below. The high school sport fee is $400 per athlete per SCHOOL YEAR. (No family cap.) Thunderbolt sport fee is $100 per athlete per sport per school year. (No family cap.) Student’s name ________________________School ____________________ Activity ___________________ Amt __________ Student’s name ________________________School ____________________ Activity ___________________ Amt __________ Student’s name ________________________School ____________________ Activity ___________________ Amt __________ Make check payable to: Lake Havasu Unified School District #1 Mail or deliver to: 2200 Havasupai Blvd. Building A, Lake Havasu City, AZ 86403-­‐3798 If mailed, a receipt will be mailed to you.

Tax credit is a dollar-­‐for-­‐dollar subtraction from your AZ state income tax liability. It’s not a donation. It is your tax dollars! Participation • Single people can participate up to $200; married filing jointly can participate up to $400. • Family and friends around the state can credit their tax funds to the Lake Havasu Schools also. • 100% of your tax credit dollars will go to the school and extra-­‐curricular activity of your choice. • You must pay by December 31. Keep your receipt for your Arizona income tax preparation. • Ask if payroll deduction, an automatic payment plan, or regular payment plan is available. How it works• It’s like pre-­‐paying your taxes and keeping the money in Havasu at the school and activity of your choice instead of sending it to Phoenix. • When you file your AZ State income tax return, subtract the tax credit amount from your tax. • Because this is a dollar-­‐for-­‐dollar credit it may reduce the amount you owe or may increase your refund. Check with your tax advisor for application of this credit. • A receipt will be issued to use with your tax form to take to your tax preparer. • The amount can be used as a deduction on an itemized Federal Tax Schedule. Recipients Tax credit money is used to help activities like band, choir, drama, sports, and many other clubs. Give your tax credit for the benefit of: • Student activities at a specific school (no activity preference) • A specific activity at a specific school (activity must be from the Approved Preference List) • A specific student (middle or high school) for use in an approved activity/sport • A student in need of an Athletic or a specific sport participation fee (middle school or high school), or for high school marching band uniforms The middle school sports fee is $100 per athlete per sport per school year. The high school sports fee is $400 per athlete per school year. Give the maximum to high school athletics or a specific high school sport and receive a free pass to the high school regular season home games for the entire school year. Steps to keep your tax credit dollars in Havasu, benefiting local students! 1. Fill out an “Extracurricular Activity Fee Tax Credit” form. 2. Drop your form and payment at any school or at the District Office, or mail your form and payment to the District Office at 2200 Havasupai Blvd. Building A, Lake Havasu City, AZ 86403. Forms must be postmarked or delivered to the district office by December 31 each year. 3. Many employers offer a payroll deduction program. Talk to your employer about this opportunity. 4. Ask about the payment plans available through the District Tax Credit office (928-­‐505-­‐6917) or Danica Kitchel, Admin. Asst., L.H.H.S. Athletic Department Office (928-­‐854-­‐5317). The deadline for accepting tax credit forms and payments is December 31 st each year. If you choose NOT to participate in the Tax Credit Program your taxes go to the State and will be utilized elsewhere. Learn more at www.havasu.k12.az.us For more information contact: Jackie Taylor, Tax Credit Lake Havasu Unified School District # 1 2200 Havasupai Blvd. Building A, Lake Havasu City, AZ 86403 928-­‐505-­‐6917 jtaylor@havasu.k12.az.us