Arizona Quarterly Withholding Tax Return (Arizona Form A1-Qrt) Page 2
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1
2Name (as shown on page 1)
EIN
Part 4
Semi-Weekly Deposit Schedule
A. First Month of Quarter (Days of the Month)
1
8
15
22
29
2
9
16
23
30
3
10
17
24
31
4
11
18
25
Check a box only if you
5
12
19
26
had a next-banking day
6
13
20
27
withholding obligation.
7
14
21
28
$
Month 1 Liability: Enter total here and on Part 2, line B1 .............................................................................................
B. Second Month of Quarter (Days of the Month)
1
8
15
22
29
2
9
16
23
30
3
10
17
24
31
Check a box only if you
4
11
18
25
5
12
19
26
had a next-banking day
6
13
20
27
withholding obligation.
7
14
21
28
$
Month 2 Liability: Enter total here and on Part 2, line B2 .............................................................................................
C. Third Month of Quarter (Days of the Month)
1
8
15
22
29
2
9
16
23
30
3
10
17
24
31
4
11
18
25
Check a box only if you
5
12
19
26
had a next-banking day
6
13
20
27
withholding obligation.
7
14
21
28
$
Month 3 Liability: Enter total here and on Part 2, line B3 .............................................................................................
Part 5
Amended Form A1-QRT Return Information
If you checked the box “Amended Return” in Part 1, explain why an amended Form A1-QRT is being filed (include additional sheets, if necessary):
Part 6
Final Form A1-QRT
If you checked the box “Final Return” in Part 1, check the box that indicates why this is a final return:
1
Reorganization or change in business entity (example: from corporation to partnership).
2
Business sold.
3
Business stopped paying wages and will not have any employees in the future.
4
Business permanently closed.
5
Business has only leased or temporary agency employees.
6
Other (specify reason):
7
Check this box if records will be kept at a location different from the address shown in Part 1.
Name:
Number and Street:
City:
State:
ZIP Code:
8
Check this box if there is a successor employer.
Name:
EIN:
Number and Street:
City:
State:
ZIP Code:
AZ Form A1-QRT (2017)
ADOR 10888 (16)
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