Arizona Form  
                                                     Arizona Quarterly Withholding Tax Return
         A1-QRT                                                                                                                                                                                                                            w
                                                                                                                                                                                            File no more than one original A1-QRT per EIN.
                    DO NOT file more than one original A1-QRT per EIN per quarter.                                                                                                          Employer Identification Number (EIN)

Part 1   Taxpayer Information (Refer to the instructions before completing Part 1.)                                                                                                         QUARTER AND YEAR*:          Q Y    Y    Y    Y
Business Name (As listed on the Arizona Joint Tax Application - Form JT-1)                              Employer Identification Number (EIN)                                                *Quarter (1, 2, 3 or 4) and four digits of year
                                                                                                                                                                                                                        Enter this number 
Number and street or PO Box                                                                             QUARTER AND YEAR                                                                    For these months:           for the quarter:
                                                                                                                                                                                            January, February, March            1
                                                                                                        Q Y Y Y Y
City or town, state and ZIP Code                                                                              Enter Quarter (1, 2, 3 or 4) and                                              April, May, June                    2
                                                                                                                                                                                           July, August, September             3
                                                                                                              four digits of year. See instructions.
Business telephone number (with area code)                                                              REVENUE USE ONLY. DO NOT MARK IN THIS AREA.                                         October, November, December         4
                                                                                                        88
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
D  Check this box if this form is being filed by the surviving employer and the periods covered        81 PM                                                                        66 RCVD
   by this return are for less than three (3) months. Also enter the following:
   Predecessor Employer Name .........  
   Predecessor Employer EIN .............  
E Total Arizona payroll for this quarter ...................................................................................................................................       $
F Total number of employees paid Arizona wages for this quarter ........................................................................................
         Tax Liability Schedule  Include all withholding amounts from all sources (i.e. wages & salary, pensions & annuities, 
Part 2   gambling winnings, etc.).  See instructions.
A. Quarterly Deposit Schedule:  Complete if prior 4 quarter average was not more than $1,500.
A1 Tax Liability. Enter the total amount withheld during the quarter.  Also enter this amount on Part 3, line 1 ...................                                                A1
                  Complete Section A above OR Section B below; DO NOT COMPLETE BOTH.
B. Monthly or Semi-Weekly/Next Day Deposit Schedule:  Complete if prior 4 quarter average was greater than $1,500.
Semi-weekly depositors and taxpayers with a next-day tax deposit obligation during the quarter, CHECK THIS BOX and complete Part 4. 
For lines B1 through B3, enter the total amount withheld for each month in the quarter.
B1 Month 1 Liability ............................................................................................................................................................. B1
B2 Month 2 Liability ............................................................................................................................................................. B2
B3 Month 3 Liability ............................................................................................................................................................. B3
B4 Total.  Enter this amount on Part 3, line 1 ......................................................................................................................              B4

Part 3   Tax Computation (See instructions.)
1  Liability:  Enter the amount from line A1 or line B4 .........................................................................................................                  1
2  Payments made during this quarter.  ..............................................................................................................................              2
3  Total Amount Due:  Subtract line 2 from line 1.  Enter the difference.  Use a minus sign to indicate a 
  negative amount. ............................................................................................................................................................    3
  Declaration  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 
               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 
               FIRM’SFIRM’S                                                                                                                                                                                                                 NAME (OR PAID PREPARER’SEINNAME, IF SELF-EMPLOYED) 
  Use 
  Only         FIRM’S STREET ADDRESS                                                                             FIRM’S TELEPHONE NUMBER

               CITY                                                                     STATE                    ZIP CODE
   Payment by EFT may be required.  See instructions.
   This form must be e-filed unless the taxpayer has a waiver or is exempt from e-filing. See instructions
ADOR 10888 (22)
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 Name (as shown on page 1)                                                                               EIN

 Part 4    Semi-Weekly/Next Day Deposit Schedule
 A.  First Month of Quarter (Days of the Month)
 1                        8                   15                                  22                                                                   29 
 2                        9                   16                                  23                                                                   30 
 3                        10                  17                                  24                                                                   31 
 4                        11                  18                                  25                                                                   Check a box only if you 
 5                        12                  19                                  26                                                                   had a next-banking day 
 6                        13                  20                                  27 
 7                        14                  21                                  28                                                                   deposit obligation.
 Month 1 Liability:  Enter total here and on Part 2, line B1 ............................................................................................. $

 B.  Second Month of Quarter (Days of the Month)
 1                        8                   15                                  22                                                                   29 
 2                        9                   16                                  23                                                                   30 
 3                        10                  17                                  24                                                                   31 
 4                        11                  18                                  25                                                                   Check a box only if you 
 5                        12                  19                                  26                                                                   had a next-banking day 
 6                        13                  20                                  27 
 7                        14                  21                                  28                                                                   deposit obligation.
 Month 2 Liability:  Enter total here and on Part 2, line B2 ............................................................................................. $

 C.  Third Month of Quarter (Days of the Month)
 1                        8                   15                                  22                                                                   29 
 2                        9                   16                                  23                                                                   30 
 3                        10                  17                                  24                                                                   31 
 4                        11                  18                                  25                                                                   Check a box only if you 
 5                        12                  19                                  26                                                                   had a next-banking day 
 6                        13                  20                                  27 
 7                        14                  21                                  28                                                                   deposit obligation.
 Month 3 Liability:  Enter total here and on Part 2, line B3 ............................................................................................. $
 Part 5    Amended Form A1-QRT Return Information
If you checked the box “Amended Return” in Part 1, explain why an amended Form A1-QRT is being filed (include additional sheets, if necessary):

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

   7     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:  

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

ADOR 10888 (22)                                 AZ Form A1-QRT (2022)                                                                                          Page 2 of 2
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