Arizona Form A1-E - Employer'S Election To Not Withhold Arizona Taxes In December - 2013
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1ARIZONA FORM
2013
Employer’s Election to Not Withhold
A1-E
Arizona Taxes in December
Name
EIN
Address (number and street or rural route)
City or town, state, and ZIP code
Number of Arizona employees
Election is hereby made to not withhold Arizona taxes from compensation paid to employees during the month of
December 2013, and certifi cation is made that all employees have been notifi ed of this and given the option of completing
a new Form A-4 to change the withholding percentage for the rest of the year.
I certify that I am authorized to make and have made the election marked above.
SIGNATURE
TELEPHONE NUMBER
DATE
Mail to: Arizona Department of Revenue, Offi ce of Economic Research & Analysis, PO Box 25248, Phoenix, AZ 85002-5248.
Print
GENERAL INSTRUCTIONS
Purpose of Form A1-E
Deadline
Form A1-E must be fi led and all employees notifi ed
Form A1-E is to be used by Arizona employers
by July 1, 2013.
to elect to not withhold Arizona taxes from
compensation paid to employees during December.
Where to Mail Form A1-E
If you make this election, it applies to all employees.
Mail Form A1-E to:
Action Required
ARIZONA DEPARTMENT OF REVENUE
• Notify all your employees in writing, informing
OFFICE OF ECONOMIC RESEARCH AND ANALYSIS
PO Box 25248
them of your election to not withhold Arizona taxes
PHOENIX, AZ 85002-5248
from their December 2013 wages and informing
them that they can, if they wish, complete Form
Duration of this Election
A-4 to adjust their Arizona withholding rate
to compensate for the change in their annual
This election is valid for December 2013 only.
withholding amount.
• Complete Form A1-E and mail it by July 1, 2013.
You only need to submit one Form A1-E for all
employees.
ADOR 10682 (12)
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