Arizona Form  
                                                Employee’s Arizona Withholding Election
               A-4                                                                                            2021

 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:
   1Withholdfrom 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.

I certify that I have made the election marked above.

SIGNATURE DATE

                                                Employee’s Instructions

Arizona law requires your employer to withhold Arizona income    Electing a Withholding Percentage of Zero
tax from your wages for work done in Arizona.  The amount 
withheld is applied to your Arizona income tax due when you      You may elect an Arizona withholding percentage of zero 
file your tax return.  The amount withheld is a percentage of    if you expect to have no Arizona income tax liability for the 
your gross taxable wages from every paycheck.  You may           current year.  Arizona tax liability is gross tax liability less any 
also have your employer withhold an extra amount from each       tax credits, such as the family tax credit, school tax credits, or 
paycheck.  Complete this form to select a percentage and any     credits for taxes paid to other states.  If you make this election, 
extra amount to be withheld from each paycheck.                  your employer will not withhold Arizona income tax from your 
                                                                 wages for payroll periods beginning after the date you file the 
What are my “Gross Taxable Wages”?                               form.  To keep this election for the next calendar year, you must 
                                                                 give your employer an updated Form A-4.  If you do not, your 
For withholding purposes, your “gross taxable wages” are the     employer may withhold Arizona income tax from your wages 
wages that will generally be in box 1 of your federal Form W-2.  and salary until you submit an updated Form A-4.
It is your gross wages less any pretax deductions, such as your 
share of health insurance premiums.                              Zero withholding does not relieve you from paying Arizona 
                                                                 income taxes that might be due at the time you file your Arizona 
New Employees                                                    income tax return.  If you have an Arizona tax liability when 
Complete this form within the first five days of your employment you file your return or if at any time during the current year 
to select an Arizona withholding percentage.  You may also       conditions change so that you expect to have a tax liability, you 
have your employer withhold an extra amount from each            should promptly file a new Form A-4 and choose a withholding 
paycheck.  If you do not give this form to your employer the     percentage that applies to you.
department requires your employer to withhold 2.7% of your 
                                                                 Voluntary Withholding Election by Certain 
gross taxable wages.
                                                                 Nonresident Employees
Current Employees                                                Compensation earned by nonresidents while physically 
If you want to change your current amount withheld, you must     working in Arizona for temporary periods is subject to Arizona 
file this form to change the Arizona withholding percentage or   income tax.  However, under Arizona law, compensation paid 
to change the extra amount withheld.                             to certain nonresident employees is not subject to Arizona 
                                                                 income tax withholding.  These nonresident employees need 
What Should I do With Form A-4?                                  to review their situations and determine if they should elect to 
Give your completed Form A-4 to your employer.                   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.
ADOR 10121 (20)