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INSTRUCTIONS: ANNUITANT'S REQUEST FOR VOLUNTARY ARIZONA INCOME TAX WITHHOLDING (Form A-4P)

Arizona residents receiving an annuity or pension may elect to have income tax voluntary withheld from these funds. This can be done by filing a form A-4P. This document can be obtained from the website maintained by the Arizona Department of Revenue.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 1: Type or print your last name, first name and middle initial in the first blank box.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 2: Enter your Social Security number in the second blank box.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 3: Enter your home street address in the third blank box.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 4: Enter your annuity contract claim or i.d. number in the fourth blank box.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 5: Enter your city or town, state and zip code in the fifth blank box.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 6: Enter your telephone number in the sixth blank box.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 7: Check the box on line 1 if electing to withhold income tax from your pension and annuity payments.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 8: Indicate with a check mark whether you wish for income tax to be withheld at the rate of 0.8%, 1.3%, 1.8%, 2.7%, 3.8%, 4.2% or 5.1%.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 9: If you wish for an additional amount of your distribution to be withheld, enter the dollar amount on the blank line.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 10: Check the box on line 2 if you are terminating a previously elected withholding.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 11: Enter your signature on the first blank line at the bottom of the page.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 12: Enter the date on the second blank line.

Annuitant's Request For Voluntary Arizona Income Tax Withholding A-4P Step 13: Send the form to the payor of your annuity or pension.