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Form A1-R 2010

This Arizona tax form is: 1) An information return used to reconcile Arizona tax withholding for the 2010 calendar year. 2) It requires the taxpayer to provide details of total Arizona tax withheld, wages paid to Arizona employees, number of Arizona employees and W-2/1099 forms submitted for reconciliation purposes. 3) The taxpayer must also provide a quarterly and annual summary of tax liability and withholding amounts reported on Arizona tax forms for the year.

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29 views

Form A1-R 2010

This Arizona tax form is: 1) An information return used to reconcile Arizona tax withholding for the 2010 calendar year. 2) It requires the taxpayer to provide details of total Arizona tax withheld, wages paid to Arizona employees, number of Arizona employees and W-2/1099 forms submitted for reconciliation purposes. 3) The taxpayer must also provide a quarterly and annual summary of tax liability and withholding amounts reported on Arizona tax forms for the year.

Uploaded by

Lisa Rowland Alexander
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Arizona Form A1-R

Arizona Withholding Reconciliation Return

Arizona Department of Revenue


PO Box 29009 - Phoenix AZ 85038-9009

2010

CHECK BOX IF:


82A
82B
filed
82 Return
60 day
under extension. 30 day
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

Taxpayer Information
Name
Number and street or PO Box
POSTMARK DATE

City or town, state, and ZIP code


Business telephone number

Check box if:

For the calendar year 2010.


Due on or before February 28, 2011.

Amended Return

Address Changed

EIN:

12/31/2010

Period End:

This Arizona Form A1-R is an information return. Do not submit any liability owed or try to claim refunds due with this return. To submit
additional liability or claim a refund, file amended quarterly withholding tax Form(s) A1-QRT.
1.
2.
3.
4.

Total Arizona Tax Withheld per federal Forms W-2, W-2c, W-2G and 1099-R ..................................................................................
Total wages paid to Arizona employees for 2010 ..............................................................................................................................
Number of Arizona employees in 2010 .............................................................................................................................................
Number of federal Forms W-2, W-2c, W-2G, and 1099-R submitted ...............................................................................................

00
00

5.

Information Return Penalty ...............................................................................................................................................................

00

Annual Summary of Amounts Reported on 2010 Arizona Forms A1-QRT


Liability Reported
6.

1st quarter

00

7.

2nd quarter

00

8.

3rd quarter

00

4th quarter

00

Total annual withholding reported

00

9.
10.

Explain why an amended Form A1-R is being filed (attach additional sheet, if necessary):

Send return to:

Arizona Department of Revenue, PO Box 29009, Phoenix AZ 85038-9009

Under penalties of perjury, I declare that I have examined this return and to the best of my knowledge and belief, it is a true, complete and correct return.
Please
Sign Here

Paid
Preparers
Use Only

Taxpayers signature

Date

Business telephone number

Preparers signature

Date

Preparers EIN, PTIN or SSN

Firms name (or preparers, if self-employed)

Firms address
ADOR 10619 (10)
Previous ADOR 91-5430

Firms EIN or SSN

Zip code

Firms telephone number

Print

Reset form

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