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Get AZ ADOR A1-WP 2004

E. (See instructions) Failure to make payment may result in a 25% penalty in addition to other penalties and interest required by law. P/M Taxpayer Information (See Instructions) Year Qtr Send to: Arizona Department of Revenue, PO Box 29009, Phoenix AZ 85038-9009 ADOR 91-1062 (04) Arizona Department of Revenue PO Box 29009 - Phoenix AZ 85038-9009 Amount of Payment Cents Dollars State Withholding Number Detach Arizona Form A1-WP Enter Quarter (1, 2, 3, or 4) and Four Positions of Year.

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