Arizona Form A1-Apr - Arizona Annual Payment Withholding Tax Return - 2016

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Arizona Form

2016

Arizona Annual Payment Withholding Tax Return

A1-APR

Form A1-APR is due on or before February 28, 2017.

If you file Form A1-QRT, do not file this form. Instead, file Form A1-R.

Part 1

Taxpayer Information

Name

Employer Identification Number (EIN)

Number and street or PO Box

DO NOT FILE MORE THAN ONE ORIGINAL

FORM A1-APR PER EIN PER YEAR.

City or town, state and ZIP Code

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

Business telephone number (with area code)



Check box if:

Amended Return

Address Change

Final Return (CANCEL ACCOUNT)

If this is your final return, the department will cancel your withholding account. Enter the date final

RCVD

M M D D Y Y Y Y

wages were paid and complete Part 6 .............................................



C heck this box if return is an early-filed return for calendar year 2017 due to an

account cancellation during 2017.



C heck this box if cancellation was due to a merger or acquisition and surviving

employer is filing Forms W-2.

Part 2

Arizona Withholding Tax Liability

1 Total Annual Withholding Tax Liability: Enter the amount withheld during the calendar year .................. 1

Part 3

Tax Payments (See instructions.)

2 Withholding tax payments previously made ............................................................................................. 2

3 Amount of tax paid when filing extension request .................................................................................... 3

4 Total payments .......................................................................................................................................... 4

5 Balance of tax due: If line 1 is larger than line 4, subtract line 4 from line 1. Enter the difference.

This is the balance of tax due. Skip line 6. Non-EFT payment must accompany return........................... 5

6 Overpayment of tax: If line 4 is larger than line 1, subtract line 1 from line 4. Enter the difference. This

is the overpayment of tax .......................................................................................................................... 6

Part 4

Federal Form Transmittal Information

7 Total amount of Arizona income tax withheld as shown on federal Forms W-2, W-2c, W-2G, and

1099-R ...................................................................................................................................................... 7

8 Total wages paid to Arizona employees .................................................................................................... 8

9 Total number of Arizona employees .......................................................................................................... 9

10 Total number of federal Forms W-2, W-2c, W-2G, and 1099-R ................................................................ 10

Instructions: If line 1 does not equal line 7, you have misreported your annual tax withholdings OR

you have misreported your employee wage withholdings.

Under penalties of perjury, I declare that I have examined this return and to the best of my knowledge and belief, it is a true, complete

Declaration

and correct return.

Please

Sign

Here

TAXPAYER’S SIGNATURE