Arizona Form 
                              Withholding Exemption Certificate for Native Americans
               WECI                                                                                  2016

 For use by tribal enrolled NATIVE  AMERICAN employees who live and are employed within an Indian 
 reservation established for that tribe and thereby claim that no  Arizona state income tax liabilities exist 
 based on the decision by the Supreme Court of the United States in              McClanahan vs.  Arizona State
 Tax Commission, 411 U.S. 164, 93 S. Ct. 1257 (1973).
 Type or print your Full Name                                                    Your Social Security Number

 Home Address – number and street or rural route                                 Tribal Census Number

 City or Town                 State              ZIP Code      Tribal Affiliation

Employee’s Certification:

I declare, under penalty of perjury, that I am a Native American residing on the 

Indian Reservation; I am an enrolled member of the tribe for which that reservation was established; and that all my 

services as an employee of                                                        are performed within the boundaries 

of that Indian reservation.  I hereby request that no Arizona state income tax be withheld and assert that no liability for 

state income taxes exists based upon the findings by the  United States Supreme Court in McClanahan vs. Arizona State

Tax Commission, 411 U.S. 164, 93 S. Ct. 1257 (1973).

EMPLOYEE’S SIGNATURE                                                             DATE

Employer:  I hereby affirm that to the best of my knowledge, the above statement is true and correct.

EMPLOYER’S SIGNATURE                                                             DATE

 NOTE:  Arizona exempts Native Americans from Arizona’s withholding requirements if the individual is living 
 and employed on a reservation, and he or she is an affiliated and enrolled member of the tribe for which that 
 reservation was established.

  • Employee:  File the completed certificate with your employer.  Keep a copy of this certificate for your records.

  • Employer:  Keep this certificate for your records.  Please do not mail this form to the Arizona Department of 
 Revenue unless requested to do so.

ADOR 10126 (15)
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