Enlarge image | Arizona Form Arizona Withholding Reconciliation Return A1-R FOR FORM A1-QRT 2022 Complete this form only if you file Form A1-QRT. Arizona Form A1-R is an information return. Do not submit any liability owed or try to claim refunds with this return. To submit additional liability or claim a refund, file amended quarterly withholding tax Form(s) A1-QRT. Form A1-R is due on or before January 31, 2023. Do NOT submit more than one A1-R per EIN per year. 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 REVENUE USE ONLY. DO NOT MARK IN THIS AREA. 88 City or town, state and ZIP Code Business telephone number (with area code) Check box if: A Amended Return B Address Change C Check this box if this return is an early-filed return for calendar year 2023 due to an account cancellation during calendar year 2023. D Check this box if this cancellation was due to a merger or acquisition and the surviving 81 PM 66 RCVD employer is filing Forms W-2. E Check this box if this form is being filed by the surviving employer and the amount on line 10 is less than the amount on line 1 because the difference was remitted by the predecessor employer. Also enter the following: Predecessor Employer Name ...................................................... Predecessor Employer EIN.......................................................... Part 2 Federal Transmittal Information 1 Total Arizona Tax Withheld per federal Forms W-2, W-2c, W-2G and 1099 for 2022 ............................. 1 2 Total Arizona wages paid to employees for 2022 ................................................................................... 2 3 Total number of employees paid Arizona wages in 2022 ........................................................................ 3 4 Total number of federal Forms W-2, W-2c, W-2G, and 1099 submitted to the department. ................... 4 5 Information Return Penalty ..................................................................................................................... 5 00 Part 3 Annual Summary of Amounts Reported on 2022 Arizona Forms A1-QRT Liability Reported 6 First Quarter ............................................................................................................ 6 7 Second Quarter ....................................................................................................... 7 8 Third Quarter ........................................................................................................... 8 9 Fourth Quarter ......................................................................................................... 9 10 Total Annual Withholding Reported ........................................................................ 10 Part 4 Explain Why an Amended Form A1-R is Being Filed (include additional sheet, if necessary) 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 TELEPHONE NUMBER Paid PAID PREPARER’S SIGNATURE DATE PAID PREPARER’S PTIN Preparer’s Use FIRM’S NAME (OR PAID PREPARER’S NAME, IF SELF-EMPLOYED) FIRM’S EIN Only FIRM’S STREET ADDRESS FIRM’S TELEPHONE NUMBER CITY STATE ZIP CODE This form must be e-filed unless the taxpayer has a waiver or is exempt from e-filing. See instructions for details. ADOR 10619 (22) Print |