2021 Quarterly Payment of                                                                        Arizona Form 
Reduced Withholding for Tax Credits                                                                      A1-QTC 
                                                                 
For information or help, call one of these numbers: 
Phoenix                                     (602) 255-3381                      Specific Instructions 
                                                                 
From  area codes 520 and 928, toll-free     (800) 352-4090      Check the box to indicate the calendar quarter for which this 
Tax forms, instructions, and other tax information              form  is completed.  
If you need tax forms, instructions, and other tax information,  Employer Information  
go to the department’s website atwww.azdor.gov. 
                                                                Type or print the employer’s name, address, and date the 
Withholding Tax Procedures and Rulings                           payment was made in the spaces provided.   
These instructions may refer to the department’s withholding 
tax procedures and rulings for more information.  To view or    Charitable Organization, School Tuition 
print these, go to our website and click on Reports & Legal     Organization,    or Public School  
Research then click on Legal Research and select a Document     Type or print the Entity’s name and mailing address in the 
Type  and Category from the drop down menus.                    spaces provided.   
Publications                                                    Enter the payment amount enclosed. This should be the total 
To view or print the department’s publications, go to our       amount   of all employees’ contributions to the Entity.  
website and click on Reports & Legal Research.  Then click 
                                                                Employee Contributions  
on Publications.                                                 
                                                                Type or print the employee’s name, address, city, state, zip 
                                                                code, phone number, and the amount of contribution to the 
                General Instructions                            entity in the spaces provided.  Total the amount of 
 
Arizona Revised Statutes § 43-401(G)  provides that an          contributions made to the entity. Enter the result on the “Total” 
employee may request that his or her employer reduce his or     line. 
her withholding in an amount equal to certain income tax        If additional schedules are included, check the box indicating 
credit(s) the employee will qualify for when filing his or her  “Check this box if additional schedules are included.”  Enter 
                                                                the total from all additional schedules on the line labeled 
income tax return. 
                                                                “Enter the total from additional schedules.” 
Purpose   of the Form                                           Add the amounts on the “Total” line and the “Total from 
This form is optional and provided as a courtesy by the Arizona additional schedules” line.  Enter the result on the “Total 
Department of Revenue.  The same result can be accomplished     Contributions”  line.   
using your own form or a letter.                                Sign and date the Form A1-QTC where indicated. Complete 
Employers use this form to report contributions made by their   the information boxes below your signature, in case the Entity 
employees to qualifying organizations,  school tuition          needs to contact you with any questions.   
organizations, and/or public schools (Entity).                  Mail the completed form to the Entity indicated in the box 
Please do not mail this form to the Arizona Department of       labeled “CHARITABLE ORGANIZATION, SCHOOL 
Revenue.  Mail the completed form to the Entity listed in the   TUITION ORGANIZATION, OR PUBLIC SCHOOL.”  
box labeled “CHARITABLE ORGANIZATION, SCHOOL                    Keep a copy of the completed form, and any attachments, for 
TUITION ORGANIZATION, OR PUBLIC SCHOOL.” Keep                   the employer’s records.   
a copy of the completed form, and any attachments, for the 
employer’s   records.