Form Ador 91-0077 Draft - Notice Of Claim By Federal Employee

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Notice to Current and Former Federal Civilian Employees
Several federal employees fi led a court action in which they argued that Arizona’s taxing scheme for years after 1990
discriminates against federal employees by adopting federal adjusted gross income, which includes federal employees’
mandatory retirement plan contributions but not those of state and local employees, as Arizona gross income. The
Arizona Supreme Court held that the tax statutes do not discriminate against federal employees based on the source of
their income. Kerr v. Killian, 207 Ariz. 181, 84 P.3d 446 (2004). The plaintiffs have fi led a Petition for Writ of Certiorari
with the United States Supreme Court. Moran v. Hibbs, No. 03-1495. We anticipate the United States Supreme Court
will decide whether to accept the Petition for Writ of Certiorari sometime in December 2004. The department will post
on its web site whether the Supreme Court accepted plaintiff’s Petition. The department’s web site may be accessed at
The statute of limitations for income tax refunds is four years. For example, claims for refund of taxes paid for 2000 must
be fi led by April 15, 2005. No statute of limitations is intended to be waived by this notice, and the department is asserting
all applicable statutes of limitations.
If you paid Arizona income tax on federal retirement plan contributions for the years ending December 31, 2000 or later, you
can fi le a claim for possible refund by mailing the notice below on or before April 15, 2005. If the courts ultimately determine
that the tax was illegal, additional information may be required by the department to determine the amount of the refunds.
Please keep copies of this claim and your federal and Arizona tax returns for all the years for which you have fi led or are
fi ling a claim along with your wage slips and any other proof of the amount of your contributions to your federal retirement
plan.
This Notice of Claim must be fi led to protect any claim you may have for 2004 or for the years 2000 through 2003 if you have
not already fi led a claim for those years.
Notice of Claim by Federal Employee
I hereby claim a refund of any Arizona income tax paid on federal retirement plan contributions made in the indicated years:
2000
2001
2002
2003
2004
YOUR FIRST NAME AND INITIAL
LAST NAME
YOUR SOCIAL SECURITY NO.
1
IF A JOINT RETURN, SPOUSE’S FIRST NAME AND INITIAL
LAST NAME
SPOUSE’S SOCIAL SECURITY NO.
1
PRESENT HOME ADDRESS - NUMBER AND STREET, RURAL ROUTE APT. NO. DAYTIME PHONE: (
)
IMPORTANT
2
You must enter your SSNs.
94
HOME PHONE: (
)
CITY, TOWN OR POST OFFICE
STATE
ZIP CODE
FOR DOR USE ONLY
3
88
_________________________________________________
________________________
81
Signature
Date
Do not mail this claim with your 2004 income tax return. Mail this claim separately to:
Federal Employee Protective Claim
Arizona Department of Revenue
PO Box 29201
Phoenix, AZ 85038-9201
ADOR 91-0077 (04)
DRAFT No. 1, Aug-2-04
DRAFT No. 1, Aug-2-04

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