Form Weci - Withholding Exemption Certicate - 2002 printable pdf download

Form Weci - Withholding Exemption Certicate - 2002

Withholding Exemption Certicate

2002

ARIZONA FORM

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 afliation

Employee’s certi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 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 af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 afliated and enrolled member of the tribe for which that reservation was established.

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

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

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

ADOR 91-0046 (01) rj

Form Weci - Withholding Exemption Certicate - 2002