Arizona Form  
                                          Arizona Annual Payment Withholding Tax Return
         A1-APR                                                                                                                                                     2022
               DO NOT FILE MORE THAN ONE ORIGINAL FORM A1-APR PER EIN PER YEAR.
                                  Form A1-APR is due on or before January 31, 2023.
                                          If you file Form A1-QRT, do not file this form.

Part 1   Taxpayer Information (Refer to the instructions before completing Part 1.)
Business Name (As listed on the Arizona Joint Tax Application - Form JT-1)                              Employer Identification Number (EIN)

Number and street or PO Box

City or town, state and ZIP Code                                                                        REVENUE USE ONLY.  DO NOT MARK IN THIS AREA.
                                                                                                        88
Business telephone number (with area code)

Check box if:
A Amended Return    B Address Change    C Final Return (CANCEL ACCOUNT)
If this is your final return, the department will cancel your withholding account. Enter the date final 
wages were paid and complete Part 6 .............................................  M M D D Y Y Y Y      81 PM                                                    66 RCVD
D  Check this box if this return is an early-filed return for calendar year 2023 due to an  
    account cancellation during calendar year 2023.
E  Check this box if this cancellation was due to a merger or acquisition and the 
    surviving employer is filing Forms W-2.

Part 2   Arizona Withholding Tax Liability
  1 Total Annual Withholding Tax Liability from all sources:  Enter the total amount withheld during the  
    calendar year ............................................................................................................................................ 1
Part 3   Tax Payments (See instructions.)
  2 Withholding tax payments previously made for 2022 ...............................................................................  2
 3  Amount of tax paid when filing extension request ....................................................................................  3
  4  Total payments ..........................................................................................................................................  4
  5  Balance of tax due:  If line 1 is larger than line 4, subtract line 4 from line 1. Enter the difference.  
    This is the balance of tax due. Skip line 6. Non-EFT payment must accompany return...........................                                              5
  6  Overpayment of tax:  If line 4 is larger than line 1, subtract line 1 from line 4. Enter the difference. This 
    is the overpayment of tax ..........................................................................................................................  6
Part 4   Federal Form Transmittal Information
  7  Total amount of Arizona income tax withheld as shown on federal Forms W-2, W-2c, W-2G, and 
    1099 for 2022 ............................................................................................................................................ 7
  8  Total Arizona wages paid to employees for 2022 .....................................................................................                      8
  9 Total number of employees paid Arizona wages for 2022 ........................................................................  9
  10  Total number of federal Forms W-2, W-2c, W-2G, and 1099 submitted to the department. ..................... 10
    Instructions:  If line 1 does not equal line 7, you have misreported your annual tax withholdings OR        
                 you have misreported your employee wage withholdings.
               Under penalties of perjury, I declare that I have examined this return and to the best of my knowledge and belief, it is a true, complete 
  Declaration
               and correct return.
  Please 
  Sign 
  Here         TAXPAYER’S SIGNATURE                                                    DATE                    BUSINESS PHONE NUMBER

  Paid         PAID PREPARER’S SIGNATURE                                               DATE                    PAID PREPARER’S TIN
  Preparer’s 
               FIRM’S NAME (OR PAID PREPARER’S NAME, IF SELF-EMPLOYED)                                         FIRM’S EIN
  Use 
  Only         FIRM’S STREET ADDRESS                                                                           FIRM’S PHONE NUMBER.

               CITY                                                                    STATE                   ZIP CODE
ADOR 10939 (22)

Name (as shown on page 1)                                                                EIN

Part 5        Amended Form A1-APR
If you checked the box “Amended Return” in Part 1, explain why an amended Form A1-APR is being filed:

Part 6        Final Form A1-APR
If you checked the box “Final Return” in Part 1, check the box that indicates why this is a final return:
  11  Reorganization or change in business entity (example:  from corporation to partnership).
  12  Business sold.
  13  Business stopped paying wages and will not have any employees in the future.
  14  Business permanently closed.
  15  Business has only leased or temporary agency employees.
  16  Other (specify reason):  

   17  Check this box if records will be kept at a location different from the address shown in Part 1.
        Name:  
        Number and Street:  
        City:                                                 State:               ZIP Code:  

   18  Check this box if there is a successor employer.
        Name:                                                                      EIN:  
        Number and Street:  
        City:                                                 State:               ZIP Code:  

Part 7        Payment and Submission of Form A1-APR
     Taxpayers with a 2022 tax liability of more than $500 must pay that tax liability by EFT.  See instructions.
     Taxpayers with a 2022 tax liability of $500 or less may pay that liability by EFT or by check.  See instructions.
      This form must be e-filed unless the taxpayer has a waiver or is exempt from e-filing. See instructions.

ADOR 10939 (22)                                      AZ Form A1-APR (2022)                                             Page 2 of 2
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