Arizona Voluntary Withholding Request for Arizona Resident Employed Outside of Arizona

Voluntary Withholding Request for Arizona Resident Employed Outside of Arizona
Arizona Form A-4V
Arizona Form

A-4V

Voluntary Withholding Request for
Arizona Resident Employed Outside of Arizona

2023

Arizona tax rates have decreased. As a result, we are revising withholding percentages and are
requiring taxpayers to complete a new Form A-4V for 2023.
	Type or print your Full Name		

Your Social Security Number

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

State	

ZIP Code

Check either box 1 or box 2:
 1	 I am an Arizona resident employed outside of Arizona. I elect to have Arizona income taxes withheld from my
compensation paid for services performed outside of Arizona for my employer as authorized by A.R.S. § 43‑408.
Withhold from gross taxable wages at the percentage checked (check only one percentage):
 0.5%	
 1.0%	
 1.5%	
 2.0%	
 2.5%	
 3.0%	
 3.5%

		  Check this box and enter an extra amount to be withheld per paycheck............................ 	$	
 2	 I am an Arizona resident employed outside of Arizona. I elect to terminate my prior election for voluntary Arizona income
tax withholding from my compensation paid for services performed outside of Arizona for my employer.

I certify that I have made the election marked above.
	

	

EMPLOYEE’S SIGNATURE	



DATE

General Instructions
Who May Use Form A-4V

What are my “Gross Taxable Wages”?

Arizona Form A-4V is for Arizona resident employees who are performing
work outside of Arizona. Use this form to request that your employer
withhold Arizona income taxes from your wages for work done outside
of Arizona. This amount is applied to your Arizona income tax due when
you file your return. Your employer is not required by statute to grant
your request.

For withholding purposes, “gross taxable wages” are the wages from
each paycheck that will generally be in box 1 of your federal Form W-2.
It is your gross wages less any pretax deductions, such as your share of
health insurance premiums.

If your employer agrees to withhold Arizona income tax from your
wages, Arizona withholding is a percentage of your gross taxable wages
of every paycheck. You may also have your employer withhold an extra
amount from each paycheck.

Complete this form to request that your employer withhold Arizona
income tax from your wages and elect an Arizona withholding percentage
and any additional amount to be withheld from each paycheck. Give
your completed form to your employer.

What Should I do With Form A-4V?

Employer Certification
	
	

(NAME OF EMPLOYER – COMPANY OR INDIVIDUAL)

	
	

(EMPLOYEE’S NAME)

, the employer of an Arizona resident,

, whose compensation is for services performed outside of Arizona,

has agreed to withhold Arizona income taxes from the employee’s compensation as authorized by A.R.S. § 43‑408. As stated in A.R.S. § 43‑408(B),
the employer understands and agrees that the employer and the employee are subject to the provisions of Chapter 4 of Title 43 of the Arizona Revised
Statutes, as if the employer were required to withhold Arizona income taxes from such compensation.

	
	 	
	 
SIGNATURE OF OFFICER, SOLE PROPRIETOR, OR AGENT		 TITLE		 DATE
ADOR 10372 (22)

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