Arizona Form A-4m - Military Election Not To Withhold
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1
2ARIZONA FORM
Military Election Not To Withhold
A-4M
For use by Arizona resident military personnel who are stationed outside of Arizona who elect not to have Arizona income taxes withheld.
NOTE: Arizona resident military personnel who are stationed in Arizona may not make this election.
Type or print full name
Social security number
Home address (number and street)
City, state, and ZIP code
Mailing address if different (number and street)
City, state, and ZIP code
I am an Arizona resident military member who is stationed outside of Arizona in compliance with
Military Member: Complete two copies and give both
military orders. As such, I elect not to have Arizona income taxes withheld from my military pay.
copies to your finance officer.
I understand that this election does not relieve me from liability for Arizona income
Finance Officer: Retain one copy and forward the other
copy to:
taxes.
Individual Audit Section
Arizona Department of Revenue
PO Box 29080
Date ____________________ Signature ________________________________________________
Phoenix AZ 85038-9080
ADOR 06-0058 (98)
ARIZONA FORM
Military Election Not To Withhold
A-4M
For use by Arizona resident military personnel who are stationed outside of Arizona who elect not to have Arizona income taxes withheld.
NOTE: Arizona resident military personnel who are stationed in Arizona may not make this election.
Type or print full name
Social security number
Home address (number and street)
City, state, and ZIP code
Mailing address if different (number and street)
City, state, and ZIP code
I am an Arizona resident military member who is stationed outside of Arizona in compliance with
Military Member: Complete two copies and give both
military orders. As such, I elect not to have Arizona income taxes withheld from my military pay.
copies to your finance officer.
Finance Officer: Retain one copy and forward the other
I understand that this election does not relieve me from liability for Arizona income
copy to:
taxes.
Individual Audit Section
Arizona Department of Revenue
PO Box 29080
Date ____________________ Signature ________________________________________________
Phoenix AZ 85038-9080
ADOR 06-0058 (98)
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