Arizona Withholding Exemption Certificate

Withholding Exemption Certificate
Arizona Form WEC
Arizona Form

WEC

2023

Employee Withholding Exemption Certificate

	Type or print your Full Name		

Your Social Security Number

	Home Address – number and street or rural route
	City or Town	

State	

ZIP Code

Native American Withholding Exemption
Part 1
	I request to have no Arizona income tax withheld from my wages because I declare that:
	

1	 I am a Native American — Enter your Tribal Census Number:

.

	

2	 I reside on the

	

3	 I am an enrolled member of the tribe for which that reservation was established.

	

4	 All my services as an employee of
the boundaries of the reservation named above.

Indian Reservation.

are performed within

Nonresident Military Spouse Withholding Exemption
Part 2
	I request to have no Arizona income tax withheld from my wages because I declare that:
	

1	 I am the spouse of an active duty servicemember.

	

2	 Both my spouse and I are Arizona nonresidents. My state of residence is
and my military spouse's state of residence is

	

3	 My active duty military spouse is in Arizona in compliance with military orders.

	

4	 I am present in Arizona solely to be with my military spouse.
My Military ID Number is:
Date Issued: M M D D Y Y Y Y

(must be the same state).

You must include a copy of your military spouse ID and your spouse's last Leave and Earnings Statement (LES).
Nonresident Withholding Exemption
Part 3
	I request to have no Arizona income tax withheld from my wages because I declare that:
	 1	 I am an Arizona nonresident, and I am a resident of:
		 California	
 Indiana	
 Oregon	
 Virginia
	

2	 I am allowed a tax credit against my Arizona taxes for taxes paid to the state checked above.

Termination
Part 4
	I am notifying my employer that I no longer qualify for the previously-claimed withholding exemption. By checking this
box, I terminate my exemption.
Part 5

Signatures

EMPLOYEE

EMPLOYER

Under penalty of perjury, I certify that I am entitled to the exemption from I have reviewed all documentation required to be submitted with this request
withholding as claimed above.
and confirm that if the employee is claiming the exemption under Part 1, that
the employee's place of employment is located on the reservation named
in Part 1.

	
	 
EMPLOYEE'S SIGNATURE		 DATE

	
	 
EMPLOYER'S SIGNATURE		 DATE

Give the completed form and any required documentation to your employer. Keep the completed form and any documentation for your records. Please
do not mail this form to the department unless you are asked to do so.
ADOR 10125 (22)

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