Arizona Form  
                                          Arizona Annual Payment Withholding Tax Return
         A1-APR                                                                                                                                                   2020
               DO NOT FILE MORE THAN ONE ORIGINAL FORM A1-APR PER EIN PER YEAR.
                                  Form A1-APR is due on or before January 31, 2021.
                                          If you file Form A1-QRT, do not file this form.

 Part 1  Taxpayer Information
Name                                                                                               Employer Identification Number (EIN)

NumberandstreetorPOBox

City or town, state and ZIP Code                                                                   REVENUE USE ONLY.  DO NOT MARK IN THIS AREA.
                                                                                                   88                                                                 89 x
Business telephone number (with area code)

Check box if:
A AmendedReturn    B Address Change    C FinalReturn (CANCELACCOUNT)
Ifthisisyourfinalreturn,thedepartmentwillcancelyourwithholdingaccount.Enterthedatefinal
wages were paid and complete Part 6 ............................................. M M D D Y Y Y Y  81 PM                                                       66 RCVD
D Checkthisboxifreturnisanearly-filedreturnforcalendaryear2021duetoan                  
   account cancellation during Calendar Year 2021.
E Checkthisboxifcancellationwasduetoamergeroracquisitionandthesurviving                           
   employerisfilingFormsW-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 2020 ............................................................................... 2
 3 Amountoftaxpaidwhenfilingextensionrequest  .................................................................................... 3
 4  Total payments .......................................................................................................................................... 4
  5  Balance of tax due:Ifline1islargerthanline4,subtractline4fromline1.Enterthedifference.               
   This is the balance of tax due. Skip line 6. Non-EFT payment must accompany return...........................                                              5
  6  Overpayment of tax:Ifline4islargerthanline1,subtractline1fromline4.Enterthedifference.               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 2020 ............................................................................................................................................ 7
 8  Total Arizona wages paid to employees for 2020 .....................................................................................                      8
 9 Total number of employees paid Arizona wages for 2020 ........................................................................ 9
 10  Total number of federal Forms W-2, W-2c, W-2G, and 1099 .................................................................... 10
   Instructions: Ifline1doesnotequalline7,youhavemisreportedyourannualtaxwithholdingsOR                    
                 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’SSIGNATURE                                                     DATE               BUSINESSPHONENUMBER

  Paid         PAIDPREPARER’SSIGNATURE                                                 DATE               PAIDPREPARER’STIN
  Preparer’s 
               FIRM’SNAME(ORPAIDPREPARER’SNAME,IFSELF-EMPLOYED)                                           FIRM’SEIN
  Use 
  Only         FIRM’SSTREETADDRESS                                                                        FIRM’SPHONENUMBER.

               CITY                                                                    STATE              ZIPCODE
ADOR 10939 (20)

Name (as shown on page 1)                                                                 EIN

Part 5         Amended Form A1-APR
Ifyoucheckedthebox“AmendedReturn”inPart1,explainwhyanamendedForm                    A1-APRisbeingfiled:
                                                                                                                   
Part 6         Final Form A1-APR
Ifyoucheckedthebox“FinalReturn”inPart1,checktheboxthatindicateswhythisisafinalreturn:
 11        Reorganizationorchangeinbusinessentity(example:fromcorporationtopartnership).
 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(specifyreason):

 17        Checkthisboxifrecordswillbe  keptatalocationdifferentfromtheaddressshowninPart1.
               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
       Make check payable to:          Arizona Department of Revenue. Include EIN on payment.
       Mail return and payment to:  Arizona Department of Revenue, PO Box 29009, Phoenix, AZ  85038-9009

ADOR 10939 (20)                                             AZ Form A1-APR (2020)                      Page 2 of 2