Form Wec - Withholding Exemption Certificate - 2004 printable pdf download

Form Wec - Withholding Exemption Certificate - 2004

2004

ARIZONA FORM

Withholding Exemption Certiﬁ cate

WEC

For use by nonresident employees who anticipate no Arizona income tax liability for the taxable year based on

eligibility of a tax credit allowance for income taxes paid to the state of domicile or residency. Arizona income tax

returns will still be required if the nonresident employee meets Arizona ﬁ ling requirements.

See Instructions on Reverse Side

Type or print full name

Social security number

Home address (number and street)

City, state, ZIP code

Employee’s certiﬁ cation: I declare that I am a resident of the state of __________________________________________

_________________ and that I am on a temporary duty assignment for my employer, ____________________________

_____________________________________ , in Arizona. I certify that as a nonresident of Arizona, I anticipate no

Arizona net income tax liability since I am eligible for a tax credit allowance under ARS § 43-1096, as amended, for income

taxes which will be paid to my state of residence or domicile for the year 2004.

Signature ____________________________________________________________ Date _______________________

Employee - File two copies of this certiﬁ cate with your employer.

Employer - Submit one copy with your next Form A1-QRT, Arizona Quarterly Withholding

Tax Return, to be ﬁ led with the Department of Revenue. Retain one copy for your records.

ADOR 91-0045 (03)

Form Wec - Withholding Exemption Certificate - 2004