Arizona Form A1-Apr - Arizona Annual Payment Withholding Tax Return - 2016 Page 2
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1
2Name (as shown on page 1)
EIN
Part 5
Amended Form A1-APR
If you checked the box “Amended Return” in Part 1, explain why an amended Form A1-APR is being filed:
Part 6
Final Form A1-APR
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):
Part 7
Other Information
Check this box if records will be kept at a location different from
Check this box if there is a successor employer. Enter the name
the address shown in Part 1. Enter the name and address of the
and address of the successor employer.
person keeping the records.
Name
Name
Number and Street
Number and Street
City
State
ZIP Code
City
State
ZIP Code
Payment and Submission of Form A1-APR
Make check payable to:
Arizona Department of Revenue. Include EIN on payment.
Mail return and payment to:
Arizona Department of Revenue, PO Box 29009, Phoenix, AZ 85038-9009
AZ Form A1-APR (2016)
Page 2 of 2
ADOR 10939 (16)
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Parent category: Financial