Fillable Form Jt-1/uc-001 - Arizona Joint Tax Application

Form Jt-1/uc-001 - Arizona Joint Tax Application - 2015 Page 4

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JT-1/UC-001 (5/15)

Page 4

Section E: AZTaxes.gov Security Administrator (Authorized User)

By electing to register for you can have online access to account information, and file and pay Arizona transaction, use, and

withholding taxes. You also designate authorized users to access these services.

I Elect to Register to use to file and pay online.

I DO NOT Elect to Register to use to file and pay online.

1. Authorized Users Last Name

2. Authorized Users First Name

3. Authorized Users Title

4. Authorized Users Social Security Number

5. Authorized Users Email Address

6. Authorized Users Phone Number

Section F: Signature(s) by individuals legally responsible for the business (required)

This application must be signed by either a sole owner, partners, corporate officer, managing member, the trustee, receiver or personal representative of an estate.

Under penalty of perjury I (we), the applicant, declare that the information provided on this application is true and correct. I (we)

hereby authorize the security administrator, if one is listed in Section E, to access the AZTaxes.gov site for the business identified in Section A. This authority is to remain

in full force and effect until the Arizona Department of Revenue has received written termination notification from an authorized officer.

Type or Print Name

Title

Signature

Date

Type or Print Name

Title

Signature

Date

THIS APPLICATION MUST BE COMPLETED, SIGNED AND RETURNED AS PROVIDED BY ARS § 23-722

Equal Opportunity Employer/Program  This document available in alternative formats by contacting the UI Tax Office.

ADOR 10194 (5/15)