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Arizona Form E-file Signature Authorization
AZ-8879 (Arizona Forms 140, 140A, 140EZ, 140NR and 140PY) 2021
Do not mail this form to the Arizona Department of Revenue. The ERO must retain this document a minimum of four years.
Your First Name and Initial Last Name Your Social Security Number*
Enter
your
Your Spouse’s First Name and Initial (if filed joint) Last Name Spouse’s Social Security No.*
SSN(s).
*Do Not Truncate
PART 1 – PURPOSE (If you are e-filing a Small Business Income Tax Return, also complete Form AZ-8879 SBI)
• To certify the truthfulness, correctness, and completeness of the taxpayer’s electronic income tax return.
• To authorize the Electronic Return Originator (ERO) to affirm that the taxpayer wishes to use the taxpayer’s electronic signature to the taxpayer’s
federal individual income tax return as the taxpayer’s signature to the taxpayer’s electronic Arizona individual income tax return.
PART 2 – TAX RETURN INFORMATION PART 3 – FINANCIAL INSTITUTION INFORMATION
Must be present when requesting direct debit or deposit.
1Arizona Adjusted Gross Income 00 Foreign Account Deposit/Debit: See instructions below.
2Balance of Tax .......................... 00 TYPE OF ACCOUNT ROUTING NUMBER
3Arizona Income Tax Withheld ... 00 Checking Savings
Check box 4 or box 5: ACCOUNT NUMBER
4 REFUND: Enter the amount of refund...................... 00
5 AMOUNT YOU OWE: Enter the amount owed ........ 00 DIRECT DEBIT REQUEST DATE DIRECT DEBIT PAYMENT AMOUNT
M M D D Y Y Y Y $ .00
Box 4 Checkbox – Refund: You are due a refund based on the information Foreign Account Deposit/Debit Checkbox: Check the “Foreign Account
provided on your tax return. Your refund amount will be deposited in the Deposit/Debit” box if your deposit will be ultimately placed in or come
account listed in the Financial Institution Information Section (Part 3). from a foreign account. If you check this box, do not enter your account
Box 5 Checkbox – Amount You Owe: You owe taxes based on the numbers. If this box is checked, we will not direct deposit or debit your
information provided on your tax return. You have elected to direct debit account. If you are due a refund, we will send you a check instead. If you
for payment. The payment will be withdrawn from the account and on the owe tax, you must mail a check to the Arizona Department of Revenue,
date listed in the Financial Institution Information Section (Part 3). PO Box 29085, Phoenix, AZ 85038-9085.
PART 4 – DECLARATION AND SIGNATURE AUTHORIZATION (Sign only after completing Part 2)
Under penalties of perjury, I declare that I have examined a copy of my I consent to my Electronic Return Originator (ERO) or On-Line Service
electronic Arizona individual income tax return and accompanying schedules Provider (OLSP) sending my electronic Arizona individual income tax
and statements for the year ending December 31, 2021, and to the best of return and accompanying schedules and statements to ADOR, and I
my knowledge and belief, it is true, correct, and complete. I further declare consent to my ERO or OLSP sending such information to ADOR through a
that the amounts of Arizona adjusted gross income, total tax, Arizona transmitter. I consent to ADOR sending my ERO, OLSP and/or transmitter
income tax withheld, and refund (or amount owed) listed above are the an acknowledgement of receipt of transmission and an indication of
amounts shown on the copy of my electronic Arizona income tax return. whether or not the transmission of my return is accepted and, if the return
6a I consent that my refund be directly deposited as designated in the is rejected, the reason(s) for the rejection. If the processing of my return
electronic portion of my 2021 Arizona individual income tax return. or refund is delayed, I authorize ADOR to disclose to my ERO, OLSP and/
If I have filed a joint return, this is an irrevocable appointment of or transmitter the reason(s) for the delay, or when the refund was sent.
the other spouse as an agent to receive the refund. If ADOR contacts my ERO for a copy of my return, any documents or
schedules to my return, and/or this authorization form, I authorize my ERO
6b I do not want direct deposit of my refund or I am not receiving a to release copies of the requested documents to ADOR.
refund.
6c I authorize the Arizona Department of Revenue (ADOR) and its
designated Financial Agent to initiate an ACH electronic funds I authorize
withdrawal (direct debit) entry to the financial institution account (ELECTRONIC RETURN ORIGINATOR)
indicated in the tax preparation software for payment of my Arizona
taxes owed on this return. I also authorize the financial institutions to make the election that I want my electronic signature to my electronic
involved in the processing of the electronic payment of taxes to federal individual income tax return to serve as my signature to my
receive confidential information necessary to answer inquiries and electronic Arizona individual income tax return for the year ending
resolve issues related to the payment. December 31, 2021. I understand that when my ERO makes the election
If I have filed a balance due return, I understand that if the ADOR does not that my electronic signature to my federal individual income tax return will
receive full and timely payment of my tax liability by April 18, 2022, I will serve as my signature to my Arizona individual income tax return, I will
remain liable for the tax liability and all applicable interest and penalties. have signed my Arizona individual income tax return and declared under
When electronically filing my federal and state tax returns, I understand penalties of perjury that to the best of my knowledge and belief the return
that if there is an error on my federal return, my state return will also be is true, correct and complete.
rejected.
YOUR PEN AND INK SIGNATURE DATE
SPOUSE’S PEN AND INK SIGNATURE DATE
PLEASE SIGN HERE
ADOR 10549 (21)
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