Arizona Form A-4 -Employee'S Arizona Withholding Percentage Election
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Employee’s Arizona Withholding
ARIZONA FORM
Percentage Election
A-4
Type or print your full name
Your social security number
Home address (number and street or rural route)
City or town, state, and ZIP code
Arizona Withholding Percentage Election Options
Choose only one:
1
My annual compensation is $15,000 or more. I choose to have Arizona withholding at the rate of
(check only one box):
19%
23%
25%
31%
37% of the federal tax withheld.
2
My annual compensation is less than $15,000. I choose to have Arizona withholding at the rate of
(check only one box):
10%
19%
23%
25%
31%
37% of the federal tax withheld.
3
I hereby elect an Arizona withholding percentage of zero, and I certify that I meet BOTH of the following qualifying conditions for this election:
•
I had NO Arizona tax liability for the prior taxable year, AND
•
I expect to have NO Arizona tax liability for the current taxable year.
I certify that I have made the percentage election marked above.
SIGNATURE
DATE
ADOR 91-0041 (07)
Employee’s Arizona Withholding
ARIZONA FORM
Percentage Election
A-4
Type or print your full name
Your social security number
Home address (number and street or rural route)
City or town, state, and ZIP code
Arizona Withholding Percentage Election Options
Choose only one:
1
My annual compensation is $15,000 or more. I choose to have Arizona withholding at the rate of
(check only one box):
19%
23%
25%
31%
37% of the federal tax withheld.
2
My annual compensation is less than $15,000. I choose to have Arizona withholding at the rate of
(check only one box):
10%
19%
23%
25%
31%
37% of the federal tax withheld.
3
I hereby elect an Arizona withholding percentage of zero, and I certify that I meet BOTH of the following qualifying conditions for this election:
•
I had NO Arizona tax liability for the prior taxable year, AND
•
I expect to have NO Arizona tax liability for the current taxable year.
I certify that I have made the percentage election marked above.
SIGNATURE
DATE
ADOR 91-0041 (07)
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