Arizona Form A1-C - Arizona Charitable Withholding Statement - 2012 Page 3
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1
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3Arizona Form
2012 Arizona Charitable Withholding Statement
A1-C
December 31, 2012) or within 15 days of termination of an
Obtain additional information or assistance by calling one of
employee whose withholding was reduced. The annual
the numbers listed below:
statement is due by January 30 of the year following the
Phoenix
(602) 255-2060
calendar year in which donations were withheld. If the due
From area codes 520 and 928, toll-free
(800) 843-7196
date falls on a Saturday, Sunday, or legal holiday, the
Hearing impaired TDD user
statement is considered timely if it is filed by the next day
Phoenix
(602) 542-4021
that is not a Saturday, Sunday, or legal holiday. Send the
From area codes 520 and 928, toll-free
(800) 397-0256
statement to the Arizona Department of Revenue, Office of
Obtain tax rulings, tax procedures, tax forms and instructions,
Economic Research and Analysis, PO Box 25248, Phoenix
and other tax information by accessing the department's
AZ 85002-5248.
Internet home page at
Filing Amended Statements
NOTE: Arizona Form A1-C for calendar year 2012 is due
If this is an amended Form A1-C, check the amended
January 30, 2013. Do not mail Form A1-C with any other
statement box. Enter the amended numbers in all areas of the
withholding form. Be sure to mail Form A1-C to the correct
form, and explain why an amended statement is being filed in
address: Arizona Department of Revenue, Office of Economic
the space provided. Include amended detail forms with the
Research and Analysis, PO BOX 25248, Phoenix, AZ 85002.
amended statement. Check the "Corrected" box on the
amended individual statements.
General Instructions
Specific Instructions
Beginning January 1, 2010, an employee can request that his
or her employer reduce his or her withholding in an amount
Type or print the name, address, and phone number in the
equal to income tax credit(s) the employee will qualify for
boxes in the Employer Information section. Check the boxes
when filing the employee's income tax return. Only the
to indicate whether this statement is an amended statement,
following credits qualify for the reduction in withholding:
and whether the address of the employer has changed.
contributions to charities that provide assistance to the
Enter the employer identification number (EIN) where indicated
working poor, provided by ARS § 43-1088 and
to the right of the employer's name and address.
claimed on Arizona Form 321;
All returns, statements, and other documents filed with the
contributions made or fees paid to public schools,
department require a taxpayer identification number (TIN).
provided by ARS § 43-1089.01 and claimed on
Taxpayers that fail to include their TIN may be subject to a
Arizona Form 322; and
penalty. Paid tax return preparers must include their TIN
contributions to private school tuition organizations,
where requested. The TIN for a paid tax return preparer is the
provided by ARS § 43-1089 and claimed on Arizona
individual's social security number, preparer tax identification
Form 323.
number, or the employer identification number of the
Who Must File Form A1-C
business. Paid tax return preparers that fail to include their
TIN may be subject to a penalty.
Employers that make payments of the reduced withholding of
Fill out one individual Charitable Withholding Statement in
its employees to charitable organizations as provided by ARS
Section II for each charity that each employee had the
§ 43-401(I)(1) must file Form A1-C, Arizona Charitable
employer make payments to on behalf of the employee. There
Withholding Statement, to report the information required by
may be several individual Charitable Withholding Statements
ARS § 43-401(I)(4). Form A1-C is also the Arizona transmittal
for each charity and for each employee. Attach continuation
statement for detail forms. These detail forms are required to be
sheet(s), if necessary. Make sure the employer's name and
filed with the Form A1-C as an integral part of the statement
EIN are included on the top of each continuation sheet.
required by the statute.
Instead of completing the individual Charitable Withholding
Instead of completing the individual Charitable Withholding
Statements, employers may substitute their own schedule as
Statements, employers may substitute their own schedule as
long as it contains the same information.
long as it contains the same information.
Box 1 - Employee Contributions Made in 2012
NOTE: Employers that file Form A1-C must still file either Form
A1-APR, Arizona Annual Payment Withholding Tax Return, or
Include the amount of reduced withholding paid to the
Form A1-R, Arizona Withholding Reconciliation Return, to
employee's chosen charity. Do not round the amount paid.
reconcile their payments and transmit federal Forms W-2, W-2c,
Box 2 - Termination Date
W-2G, and/or 1099-R, if those forms include Arizona withholding.
Mail each form to the address on the form, by the correct due date.
Enter the termination date of the employee, if applicable.
Filing Original Statements
Provide a copy of the Individual Charitable Withholding
Statement to the employee. Maintain a copy of the statements
This statement must be filed annually, on a calendar year
for the employer's records.
basis (i.e., for the period January 1, 2012, through
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