Form A1-Qtc Draft - 2014 Quarterly Payment Of Reduced Withholding For Tax Credits printable pdf download

Form A1-Qtc Draft - 2014 Quarterly Payment Of Reduced Withholding For Tax Credits

Quarterly Payment of

2014

Arizona Form A1-QTC

Reduced Withholding for Tax Credits

Please do not mail this form to the

Arizona Department of Revenue.

Employer’s Address – Number and street or PO Box

Employer’s City, State and ZIP code

Date

TO:

Entity Name

Entity Address – Number and street or PO Box

Entity City, State and ZIP code

RE: Calendar Year 2014

Enclosed is $__________________ in payment of reduced withholding donations, made on behalf of all employees noted

below. Issue a receipt to each employee for the amount indicated.

EMPLOYEE 1

EMPLOYEE 2

EMPLOYEE 3

Employee’s Name:

Employee’s Street Address:

Employee’s City, State, ZIP Code:

Phone Number (with area code):

Amount Enclosed:



If this box is checked, additional forms are attached.

Please contact me if you have any questions.

Sincerely,

SIGNATURE OF PAYROLL DEPARTMENT REPRESENTATIvE

DATE

PRINT NAME

TITLE

COMPANY NAME

PhONE NUMBER (with area code)

E-MAIL ADDRESS

Please do not mail this form to the Arizona Department of Revenue.

DRAFT #3, Aug-1-13

ADOR 10762 (13)

DRAFT #1, Aug-27-13

Form A1-Qtc Draft - 2014 Quarterly Payment Of Reduced Withholding For Tax Credits