Blank Arizona A 4P PDF Template Modify Form Now

Blank Arizona A 4P PDF Template

The Arizona A-4P form is a document used by individuals receiving annuity or pension payments to request voluntary Arizona income tax withholding. This form allows you to choose a specific percentage of your taxable distribution to be withheld for state taxes. Completing the A-4P ensures that your tax obligations are managed appropriately, providing peace of mind regarding your financial responsibilities.

Modify Form Now
Overview

The Arizona A 4P form serves as an essential tool for individuals receiving annuity or pension payments who wish to manage their state income tax withholding. This form allows annuitants to voluntarily elect Arizona income tax withholding from their payments, ensuring that they meet their tax obligations in a timely manner. When filling out the A 4P, users will need to provide personal information, including their full name, social security number, and address, along with details about their annuity contract. Importantly, the form offers several withholding rate options, ranging from 0.8% to 5.1%, giving individuals the flexibility to choose a rate that aligns with their financial situation. Additionally, the form allows for the specification of an extra amount to be withheld if desired. Should an individual decide to change their withholding preferences or terminate their election altogether, the A 4P provides a straightforward process for doing so. It's crucial to note that this form should be submitted to the payor of the annuity or pension, rather than the Arizona Department of Revenue, ensuring that the correct entity processes the request. Overall, the Arizona A 4P form is a vital resource for managing tax withholding effectively, helping individuals navigate their financial responsibilities with ease.

Form Example

ARIZONA FORM

Annuitant’s Request for

2012

A-4P

Voluntary Arizona Income Tax Withholding

 

Type or print your full name (last, fi rst, middle initial)

Your social security number

Home address (number and street or rural route)

Annuity Contract Claim or I.D. Number

City or town, state, and ZIP code

Telephone Number

Annuitant’s Voluntary Arizona Income Tax Withholding Options

Choose only one:

1! I hereby elect to have Arizona income taxes withheld from my annuity or pension payments as authorized by ARS §43-404. I choose to have Arizona withholding at the rate of

(check only one box): ! 0.8% ! 1.3% ! 1.8% ! 2.7% ! 3.6% ! 4.2% ! 5.1% of the taxable amount of distribution.

Additional amount to be withheld per distribution $

2! I hereby elect to terminate my prior election for voluntary Arizona income tax withholding from my annuity or pension payments as authorized by ARS §43-404.

I certify that I have made the percentage election marked above.

SIGNATURE

DATE

GENERAL INSTRUCTIONS

Who May Use Form A-4P

A person who receives an annuity or pension may use this form to elect voluntary Arizona income tax withholding. Arizona withholding is a percentage of the taxable amount of distribution in Box 2a of federal Form 1099-R. Therefore, you may elect voluntary Arizona income tax withholding at the applicable percentage rates and designate an additional amount to be withheld.

“Annuity” means any amount paid to an individual as a pension or annuity, but only to the extent that the amount is includible in the Arizona gross income of that individual.

You may NOT elect to have Arizona income tax withheld from nonperiodic payments, lump sum distributions, or individual retirement account distributions, that do not meet the defi nition of annuity listed above.

You also may NOT elect to have Arizona income tax withheld from Social Security pensions, Veteran’s Administration annuities, or Railroad Retirement pensions.

Where to Send Form A-4P

Send Form A-4P to the payor of your annuity or pension. Do not send Form A-4P to the Arizona Department of Revenue.

Duration of Voluntary Arizona Withholding Election

The payor of your pension or annuity will withhold Arizona income tax from your payments until you notify the payor to terminate Arizona withholding.

How to Terminate a Voluntary Arizona Withholding Election

You may terminate your voluntary Arizona withholding election at any time. You may use Form A-4P to terminate Arizona withholding or you may send a written notice to the payor of your pension or annuity requesting termination of withholding.

Statement of Income Tax Withheld

The payor of your pension or annuity will provide you with a form that lists the total amount of your pension or annuity payments and the total amount of Arizona income tax withheld from these payments for the calendar year 2012. The payor of your pension or annuity will provide this form to you in early 2013.

ADOR 10122 (11)

Document Characteristics

Fact Name Details
Purpose of Form A-4P This form allows individuals receiving annuity or pension payments to elect voluntary Arizona income tax withholding.
Governing Law The form is governed by Arizona Revised Statutes (ARS) §43-404, which outlines the rules for income tax withholding.
Eligible Individuals Anyone receiving an annuity or pension can use this form. However, it cannot be used for nonperiodic payments or certain retirement distributions.
Withholding Rates Individuals can choose from several withholding rates: 0.8%, 1.3%, 1.8%, 2.7%, 3.6%, 4.2%, or 5.1% of the taxable amount.
Termination of Withholding Withholding can be terminated at any time by notifying the payor or using Form A-4P again.
Submission Instructions Form A-4P should be sent directly to the payor of the annuity or pension, not to the Arizona Department of Revenue.
Annual Tax Statement The payor will provide an annual statement detailing the total payments and amount withheld for the calendar year.
Please rate Blank Arizona A 4P PDF Template Form
4.78
(Excellent)
18 Votes

Fill out Other Forms