Type or print your Full Name Your Social Security Number
Home Address – number and street or rural route
City or Town State ZIP Code
Choose either box 1 or box 2:
1 Withhold from gross taxable wages at the percentage checked (check only one percentage):
0.8% 1.3% 1.8% 2.7% 3.6% 4.2% 5.1%
Check this box and enter an extra amount to be withheld from each paycheck ................ $
2 I elect an Arizona withholding percentage of zero, and I certify that I expect to have
no Arizona tax liability for the current taxable year.
Employee’s Instructions
Arizona law requires your employer to withhold Arizona income
tax from your wages for work done in Arizona. This amount
is applied to your Arizona income tax due when you file your
tax return. The amount withheld is a percentage of your gross
taxable wages of every paycheck. You may also have your
employer withhold an extra amount from each paycheck.
Complete this form to select a percentage and any extra
amount to be withheld from each paycheck.
What are my “Gross Taxable Wages”?
For withholding purposes, your “gross taxable wages” are the
wages that will generally be in box 1 of your federal Form W-2.
It is your gross wages less any pretax deductions, such as your
share of health insurance premiums.
New Employees
Complete this form in the first five days of employment to select
an Arizona withholding percentage. You may also have your
employer withhold an extra amount from each paycheck. If you
do not file this form, the department requires your employer to
withhold 2.7% of your gross taxable wages.
Current Employees
If you want to change the current amount withheld, you must
file this form to change the Arizona withholding percentage or
change the extra amount withheld.
What Should I do With Form A-4?
Give your completed Form A-4 to your employer.
Electing a Withholding Percentage of Zero
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 file
the form. Zero withholding does not relieve you from paying
Arizona income taxes that might be due at the time you file
your Arizona income tax return. If you have an Arizona tax
liability when you file your return or if at any time during the
current year conditions change so that you expect to have a tax
liability, you should promptly file a new Form A-4 and choose a
percentage that applies to you.
Voluntary Withholding Election by Certain
Nonresident Employees
Compensation earned by nonresidents while physically working
in Arizona for temporary periods is subject to Arizona income
tax. However, under Arizona law, compensation paid to certain
nonresident employees is not subject to Arizona income tax
withholding. These nonresident employees need to review
their situations and determine whether they should elect to
have Arizona income taxes withheld from their Arizona source
compensation. Nonresident employees may request that their
employer withhold Arizona income taxes by completing this
form to elect Arizona income tax withholding.
I certify that I have made the election marked above.
SIGNATURE DATE
ADOR 10121 (15)
Arizona Form
A-4
Employee’s Arizona Withholding Election
2016
