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Arizona Free Printable Employer Affidavit for 2024 Arizona Employer Affidavit

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Employer Affidavit
Employer Affidavit

ARIZONA DEPARTMENT OF REVENUE EMPLOYER AFFIDAVIT TO BE COMPLETED BY THE EMPLOYEE I hereby certify that the Arizona Department of Revenue is authorized to release to my employer confidential information concerning me for tax years to verify my Arizona wages and withholding. SIGNATURE DATE SIGNATURE DATE PRINT NAME PRINT NAME TO BE COMPLETED BY THE EMPLOYER Date: To: Arizona Department of Revenue From: Name of Business Employer Identification Number (EIN) Business Location Address Telephone Number City RE: State Calendar Year Employment of: ZIP Code (Legal name of employee) During calendar year I employed the person named above. My records show that the above-named employee submitted a Social Security Number of which I used for employment purposes. For calendar year this employee had: Total wages earned: $ Total Arizona tax withheld: $ I DECLARE UNDER PENALTIES OF PERJURY THAT ALL THE INFORMATION I HAVE PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. Signature of Employer or Employer’s Authorized Agent Title Print Name STATE OF ) COUNTY OF ) Subscribed and sworn (or affirmed) before me this , by: PRINT NAME OF SIGNOR (Notary Seal) NOTARY PUBLIC ADOR 11161 (6-23) Name used on tax return day of , 20 FOR DOR USE ONLY Identification number used on tax return __ __ __ - __ __ - __ __ __ __ Please return to: Arizona Department of Revenue PO Box 29099 Phoenix, AZ 85038-9099 or [email protected]
Extracted from PDF file 2023-arizona-form-11161.pdf, last modified March 2018

More about the Arizona Form 11161 Individual Income Tax TY 2023

This form is used by the employer to let the ADOR know extra details due to a discrepancy in SSN.

We last updated the Employer Affidavit in February 2024, so this is the latest version of Form 11161, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form 11161 directly from TaxFormFinder. You can print other Arizona tax forms here.

Other Arizona Individual Income Tax Forms:

TaxFormFinder has an additional 95 Arizona income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form 140 Resident Personal Income Tax Return
Form 140 Instructions Income Tax Instruction Packet
Form 140A Resident Personal Income Tax (Short) Package
Form 204 Application for Filing Extension
Form 321 Credit for Contributions to Qualifying Charitable Organizations

Download all AZ tax forms View all 96 Arizona Income Tax Forms


Form Sources:

Arizona usually releases forms for the current tax year between January and April. We last updated Arizona Form 11161 from the Department of Revenue in February 2024.

Show Sources >

About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Arizona Form 11161

We have a total of three past-year versions of Form 11161 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2023 Form 11161

Employer Affidavit

2022 Form 11161

Employer Affidavit

2021 Form 11161

Employer Affidavit


TaxFormFinder Disclaimer:

While we do our best to keep our list of Arizona Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.

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Source: http://www.taxformfinder.org/index.php/arizona/form-11161