NOTICE: AZDOR.gov, AZTaxes.gov and the Luxury Tax Online site will be unavailable due to scheduled maintenance starting Friday, December 13, 2019 at 6:00 p.m. The website will be back online by Monday, December 16. We apologize for any inconvenience.
Previously used by employers that made payments of reduced withholding from employees to charitable organizations to report the amount(s) withheld and paid on behalf of their employees. The form was submitted to the department. This form is no longer required.
Used by employers to reconcile the amount(s) of Arizona income tax withheld and deposited with the Department of Revenue. This form must be completed and filed 4 times a year, April 30, July 31, October 31, and January 31 of the following year.
Annuitant's Request for Voluntary Arizona Income Tax Withholding
Residents who receive regularly scheduled payments from payments or annuities complete this form to elect to have Arizona income taxes withheld from their payments. This form is submitted to the payer not the department.
If ADOR received your Arizona income tax return and found that the social security number (SSN) and/or name on the W-2 form do not match the identification number and/or name on the tax return, ADOR will need to verify the withholding amount shown on the return before it can issue a refund. To accomplish the verification, ADOR must obtain additional information from you.