Arizona Form Weci - Withholding Exemption Certificate Native Americans - 2012
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1ARIZONA FORM
Withholding Exemption Certifi cate
2012
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 (last, fi rst, middle initial)
Your social security number
Home address (number and street or rural route)
Tribal census number
City, state, and 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)
Print
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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 completed certifi cate with your employer.
Employer - Keep this certifi cate for your records. You only need to provide a copy to the Department upon request.
ADOR 10126 (11)
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