Arizona Form Wec - Withholding Exemption Certificate - 2012
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1
2ARIZONA FORM
Withholding Exemption Certifi cate
2012
WEC
For use by nonresident employees who anticipate no Arizona income tax liability for the taxable year based
on eligibility of a tax credit allowance for income taxes paid to the state of domicile or residency. Arizona
income tax returns will still be required if the nonresident employee meets Arizona fi ling requirements.
See Instructions on Reverse Side.
Type or print full name (last, fi rst, middle initial)
Your social security number
Home address (number and street or rural route)
City, state, and ZIP code
Employee’s certifi cation: I declare that I am a resident of the state of
and that I am on a temporary duty assignment for my employer,
, in Arizona. I certify that as a nonresident of Arizona, I anticipate no Arizona
net income tax liability since I am eligible for a tax credit allowance under ARS § 43-1096, as amended, for income taxes
which will be paid to my state of residence or domicile for the year 2012.
Signature
Date
Print
Reset form
Employee - File the 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 10125 (11)
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