This the Arizona tax witholding form. You can create this for use on https://inkdit.com

Arizona A-4

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    <p>ARIZONA FORM<br>
      <strong>A-4</strong></p>
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    <h2 style="text-align: center;">Employee's Arizona Withholding Percentage Election</h2>
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    <p style="text-align: right;"><strong>2013</strong></p>
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    <label>Type your full name </label>
    <input name="Name" type="text" class="custom-input required custom-input required custom-input required" data-required="required">
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    <label>Your social security number</label>
    <input name="Social Security Number" type="text" class="custom-input required custom-input required custom-input required" data-required="required">
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    <label>Home address (number and street or rural route)</label>
    <input name="Home Address" type="text" class="custom-input required custom-input required custom-input required" data-required="required">
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    <label>City or town, state, and ZIP code</label>
    <input name="City or town, state, and ZIP code" type="text" class="custom-input required custom-input required custom-input required" data-required="required">
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  <legend>Arizona Withholding Percentage Election Options</legend>
  <div class="row">Choose only one:</div>
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      <label>
        <input name="Percentage Election Option" type="radio" value="Withold" class="custom-input custom-input custom-input">
        I choose to have Arizona withholding at the rate of
        <select name="Rate" class="custom-input custom-input">
          <option value="0.8%">0.8%</option>
          <option value="1.3%">1.3%</option>
          <option value="1.8%">1.8%</option>
          <option value="2.7%">2.7%</option>
          <option value="3.6%">3.6%</option>
          <option value="4.2%">4.2%</option>
          <option value="5.1%">5.1%</option>
        </select>
        of my gross taxable wages.</label>
      <label>Additional amount to be withheld per paycheck $
        <input name="Additional amount to be withheld" class="custom-input custom-input">
      </label>
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      <label>
        <input name="Percentage Election Option" type="radio" value="Do not withold" class="custom-input custom-input custom-input">
        I hereby elect an Arizona withholding percentage of zero, and I certify that I expect to have no Arizona tax liability for the current taxable year.</label>
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<p><strong>I certify that I have made the percentage election marked above.&nbsp;</strong></p>
<p><strong><img width="100%" class="placeholder-signing-line" src="/assets/sign-line-editor-graphic-2fb6d67c8a5a7d0acc07baf78cc08807.png" height="194"></strong></p>
<h3>EMPLOYEE’S INSTRUCTIONS</h3>
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    <p>Arizona law requires your employer to withhold Arizona income tax from your wages for work done in Arizona. This amount is applied to your Arizona income tax due when you file your tax return. The amount withheld 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 select a percentage and any extra amount to be withheld from each paycheck.</p>
    <p><strong>What are my "Gross Taxable Wages"?</strong></p>
    <p>For withholding purposes, your "gross taxable wages" are the wages 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.</p>
    <p><strong>New Employees</strong></p>
    <p>Complete this form in the first five days of employment to select an Arizona withholding percentage. You may also have your employer withhold an extra amount from each paycheck. If you do not file this form, the department requires your employer to withhold 2.7% of your gross taxable wages.</p>
    <p><strong>Current Employees</strong></p>
    <p>If you want to change the current amount withheld, you must file this form to change the Arizona withholding percentage or change the extra amount withheld.</p>
    <p><strong>What Should I do With Form A-4?</strong></p>
    <p>Give your completed Form A-4 to your employer.</p>
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    <p><strong>Electing a Withholding Percentage of Zero</strong></p>
    <p>You may elect an Arizona withholding percentage of zero if you expect to have no Arizona income tax liability for the current year. Arizona tax liability is gross tax liability less any tax credits, such as the family tax credit, school tax credits, or credits for taxes paid to other states. If you make this election, your employer will not withhold Arizona income tax from your wages for payroll periods beginning after the date you file the form. Zero withholding does not relieve you from paying Arizona income taxes that might be due at the time you file your Arizona income tax return. If you have an Arizona tax liability when you file your return or if at any time during the current year conditions change so that you expect to have a tax liability, you should promptly file a new Form A-4 and choose a percentage that applies to you.</p>
    <p><strong>Voluntary Withholding Election by Certain Nonresident Employees</strong></p>
    <p>Compensation earned by nonresidents while physically working in Arizona for temporary periods is subject to Arizona income tax. However, under Arizona law, compensation paid to certain nonresident employees is not subject to Arizona income tax withholding. These nonresident employees need to review their situations and determine whether they should elect to have Arizona income taxes withheld from their Arizona source compensation. Nonresident employees may request that their employer withhold Arizona income taxes by completing this form to elect an Arizona withholding percentage.</p>
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<pre>ADOR 10121 (12)</pre>