Employee's Arizona Withholding Election
Employee Name
*
Email
*
example@example.com
Your Social Security Number
*
Withhold from gross taxable wages at the percentage checked (check only one percentage):
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
Check this box and enter an extra amount to be withheld from each paycheck
Other
I elect an Arizona withholding percentage of zero
I certify that I have made the election marked above.
Type Signature
*
DATE
-
Month
-
Day
Year
Date
You may elect an Arizona withholding percentage of zero if you expect to have no Arizona income tax liability for the current year. Arizona tax liability is gross tax liability less any tax credits, such as the family tax credit, school tax credits, or credits for taxes paid to other states. If you make this election, your employer will not withhold Arizona income tax from your wages for payroll periods beginning after the date you
Submit
Should be Empty: