Arizona Form Weci - Withholding Exemption Certificate Native Americans - 2005
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12005
ARIZONA FORM
Withholding Exemption Certifi cate
WECI
Native Americans
For use by tribal enrolled NATIVE AMERICAN employees who live and are employed within an Indian
reservation established for that tribe and thereby claim that no Arizona state income tax liabilities exist
based on the decision by the Supreme Court of the United States in McClanahan vs. Arizona State Tax
Commission, 411 U.S. 164, 93 S. Ct. 1257 (1973).
Type or print full name
Social security number
Home address (number and street)
Tribal census number
City, state, ZIP code
Tribal affi liation
Employee’s certifi cation: I declare, under penalty of perjury, that: I am a Native American residing on ________________
_____________ Indian reservation; I am an enrolled member of the tribe for which that reservation was established; and
all my services as an employee of __________________________________________________ are performed within
the boundaries of that Indian reservation. I hereby request that no Arizona state income tax be withheld and assert that
no liability for state income taxes exists based upon the fi ndings by the United States Supreme Court in McClanahan vs.
Arizona State Tax Commission, 411 U.S. 164, 93 S. Ct. 1257 (1973).
Signature ____________________________________________________________ Date _______________________
I hereby affi rm that to the best of my knowledge, the above statement is true and correct.
_________________________________________________________
(Employer)
NOTE: Arizona exempts Native Americans from Arizona’s withholding requirements if the individual is living and employed
on a reservation, and he or she is an affi liated and enrolled member of the tribe for which that reservation was established.
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 91-0046 (04)
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