JT-1/UC-001 (12/17)
ARIZONA JOINT TAX APPLICATION (JT-1)
License and Registration
ARIZONA DEPARTMENT OF REVENUE
PO BOX 29032
Phoenix, AZ 85038-9032
IMPORTANT! Incomplete applications WILL NOT BE PROCESSED.
•Please read form instructions while completing the application. Additional information and forms available at www.azdor.gov
•Required information is designated with an asterisk (*).
•Return completed application AND applicable license fee(s) to address shown at left.
•For licensing questions regarding transaction privilege tax, call Customer Care and Outreach: (602) 255-3381
You can register, file
and pay for this
application online at www.AZTaxes.gov. It is fast and secure.
SECTION A: Business Information
1* Federal Employer Identification Number
or Social Security Number, required if sole proprietor with no employees
2* License Type – Check all that apply: |
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Transaction Privilege Tax (TPT) |
Use Tax |
Withholding/Unemployment Tax (if hiring employees) |
TPT for Cities ONLY |
3* Type of Organization/Ownership – Tax exempt organizations must attach a copy of the Internal Revenue Service’s letter of determination.
Individual/Sole Proprietorship |
Subchapter S Corporation |
Government |
Joint Venture |
Corporation |
Association |
Estate |
Receivership |
State of Inc. |
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Partnership |
Trust |
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Date of Inc. M M D D Y Y Y Y |
Limited Liability Company |
Limited Liability Partnership |
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4* Legal Business Name
5* Mailing Address – number and street |
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ZIP Code |
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6* Business Phone No. (with area code) |
7 Email Address |
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Fax Number (with area code) |
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9* Description of Business: Describe merchandise sold or taxable activity. |
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10* NAICS Codes: Available at www.azdor.gov |
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11* Did you acquire or change the legal form of an existing business? |
12* Are you a construction contractor? |
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No Yes You must complete Section F. |
No Yes (see bonding requirements) |
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BONDING REQUIREMENTS: Prior to the issuance of a Transaction Privilege Tax license, new or out-of-state contractors are required to post a Taxpayer Bond for Contractors unless the contractor qualifies for an exemption from the bonding requirement. The primary type of contracting being performed determines the amount of bond to be posted. Bonds may also be required from applicants who are delinquent in paying Arizona taxes or have a history of delinquencies. Refer to the publication, Taxpayer Bonds, available online at www.azdor.gov or in Arizona Department of Revenue offices.
WITHHOLDING LICENSE ONLY
13* Withholding Physical Location |
City |
State |
ZIP Code |
Number and street (Do not use PO Box, PMB or route numbers) |
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Continued on page 2
CASHIER’S STAMP ONLY. DO NOT MARK IN THIS AREA.
New
Change
Revise
Reopen
ACCOUNT NUMBER |
DLN |
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START |
TRANSACTION PRIVILEGE TAX |
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S/E DATE |
WITHHOLDING / SSN / EIN |
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COMPLETED DATE |
EMPLOYEE’S NAME |
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LIABILITY |
LIABILITY ESTABLISHED |
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JT-1/UC-001 (12/17)
Name (as shown on page 1)
FEIN or SSN (as shown on page 1)
SECTION B: Identification of Owners, Partners, Corporate Officers Members/Managing Members or Officials of this Employing Unit
If you need more space, attach Additional Owner, Partner, Corporate Officer(s) form available at www.azdor.gov. If the owner, partners, corporate officers or combination of partners or corporate officers, members and/or managing members own more than 50% of or control another business in Arizona, attach a list of the businesses, percentages owned and unemployment insurance account numbers or provide a Power of Attorney (Form 285) which must be filled out and signed by an authorized corporate officer.
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*Social Security No. |
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*Title |
1 |
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Owner |
*Street Address |
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*ZIP Code |
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*County |
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*Social Security No. |
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*Title |
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2 |
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Owner |
*Street Address |
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*ZIP Code |
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*County |
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*Social Security No. |
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*Title |
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3 |
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Owner |
*Street Address |
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*ZIP Code |
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*County |
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*Last Name |
First Name |
Middle Intl. |
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*City |
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*State |
* % Owned |
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*Phone Number (with area code) |
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*Country |
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*Last Name |
First Name |
Middle Intl. |
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*City |
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*State |
* % Owned |
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*Phone Number (with area code) |
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*Country |
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*Last Name |
First Name |
Middle Intl. |
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*City |
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*State |
* % Owned |
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*Phone Number (with area code) |
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*Country |
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SECTION C: Transaction Privilege Tax (TPT)
1* Date Business Started in Arizona 2* Date Sales Began |
3 What is your Estimated Tax Liability for your first twelve months of business? |
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4 |
Filing Frequency Monthly |
Quarterly |
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Seasonal Annual |
If seasonal filer, check the months for which you intend to do business: |
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JAN FEB MAR |
APR MAY |
JUN JUL |
AUG |
SEP OCT NOV DEC |
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Does your business sell tobacco products? |
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TPT Filing Method |
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7 |
Does your business sell new motor vehicle tires or vehicles? |
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Yes Retailer OR Distributor |
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Cash Receipts |
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Yes You will have to file Motor Vehicle Tire Fee form |
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Accrual |
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available at www.azdor.gov |
8* Tax Records Physical Location – number and street |
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City |
State ZIP Code |
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(Do not use PO Box, PMB or route numbers) |
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County
9* Name of Contact
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* Phone Number (with area code) |
Extension |
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SECTION D: Transaction Privilege Tax (TPT) Physical Location
1* Business Name, “Doing Business As” or Trade Name at this Physical Location
2* Phone Number (with area code)
3* Physical Location of Business or Commercial/Residential Rental |
City |
State |
ZIP Code |
Number and street (Do not use PO Box, PMB or route numbers) |
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County/Region |
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Residential Rental Only – Number of Units
Reporting City (if different than the physical location city)
4* Additional County/Region Indian Reservation/City: County/Region Indian Reservation and City Codes available at www.azdor.gov
County/ |
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Region |
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City |
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Business Codes (Include all codes that apply): |
See instructions. Complete list available at www.azdor.gov |
State/ |
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County |
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If you have more locations, attach Additional Business Locations form available at www.azdor.gov
ADOR 10196 (3/22) |
ARIZONA JOINT TAX APPLICATION (JT-1) |
Page 2 of 4 |
JT-1/UC-001 (12/17)
Name (as shown on page 1)
FEIN or SSN (as shown on page 1)
SECTION E: Withholding & Unemployment Tax Applicants
1* Regarding THIS application, Date Employees First Hired in Arizona |
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Are you liable for Federal Unemployment Tax? |
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Y Y Y Y |
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Yes First year of liability: Y |
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3 Are individuals performing services that are excluded from withholding |
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Do you have an IRS ruling that grants an exclusion from |
or unemployment tax? |
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Federal Unemployment Tax? |
Yes Describe services: |
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Yes Attach a copy of the Ruling Letter. |
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5Do you have, or have you previously had, an Arizona unemployment tax number?
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No |
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Unemployment Tax Number: |
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Yes Business Name: |
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6 |
First calendar quarter Arizona employees were/will be hired and paid |
Hired Year |
Hired Quarter |
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Paid Year |
Paid Quarter |
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(indicate quarter as 1, 2, 3, 4): |
Y Y Y Y |
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Y Y Y Y |
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7 |
When did/will you first pay a total of $1,500 or more gross wages in a calendar quarter? |
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Year |
Quarter |
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(indicate quarter as 1, 2, 3, 4) |
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Y Y Y Y |
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Exceptions: $20,000 gross cash wages Agricultural; $1,000 gross cash wages Domestic/Household; not applicable to 501(c)(3) Non-Profit. |
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When did/will you first reach the 20th week of employing 1 or more individuals for some portion of a day in |
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Year |
Quarter |
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each of 20 different weeks in the same calendar year? (indicate quarter as 1, 2, 3, 4) |
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Y Y Y Y |
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Exceptions: 10 or more individuals Agricultural; 4 or more individuals 501(c)(3) Non-Profit; not applicable to Domestic/Household. |
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SECTION F: Acquired Business Information
If you answered “Yes” to Section A, question 11, you must complete Section F.
1* Did you acquire or change all or part of an existing business? |
2* |
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Date of Acquisition |
3* EIN of Business Under Previous Owner |
All |
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4* Previous Owner’s Telephone Number |
5* Name of Business Under Previous Owner |
6* Name of Previous Owner |
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7* Did you change the legal form of all or part of the Arizona operations of |
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Date of Change |
9* EIN of Previous Legal Form |
your existing business? (e.g., change from sole proprietor to corporation or etc.) |
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SECTION G: AZTaxes.gov Security Administrator
Visit www.AZTaxes.gov (the Arizona Department of Revenue’s online customer service center) to register for online services. The authorized individual will have full online access to transaction privilege, use, withholding and corporate tax account information and services. The authorized individual will be able to add or delete users and grant user privileges. Online services include viewing tax account information, filing tax returns, signing returns electronically with a Self-Select Personal Identification Number (PIN) and remitting tax payments.
SECTION H: Required Signatures
This application must be signed by either a sole owner, at least two partners, managing member or corporate officer legally responsible for the business, trustee or receiver or representative of an estate that has been listed in Section B.
This application must be completed, signed, and returned as provided by A.R.S. § 23-722.
Equal Opportunity Employer/Program
This application is available in alternative formats at Unemployment Insurance Tax Office.
PLEASE COMPLETE SECTION I: STATE/COUNTY & CITY LICENSE FEE WORKSHEET
TO CALCULATE AND REMIT TOTAL AMOUNT DUE WITH THIS APPLICATION.
ADOR 10196 (3/22) |
ARIZONA JOINT TAX APPLICATION (JT-1) |
Page 3 of 4 |