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JT-1/UC-001 (12/03)

ARIZONA JOINT TAX APPLICATION

	IMPORTANT: See attached instructions before completing this
	IMPORTANT: See attached instructions before completing this
	application. For licensing questions on Transaction Privilege,	To complete this online, go to
	Withholding or Use call (602) 542-4576 or 1-800-634-6494 (from	To complete this online, go to
	area codes 520 and 928). For questions on Unemployment Tax call	www.aztaxes.gov
	(602) 248-9396 or e-mail uit.status@mail.de.state.az.us. Please	www.aztaxes.gov

	return complete application to: Licensing & Registration Section,
		Incomplete applications will not be processed.
	Department of Revenue, 1600 W Monroe, Phoenix AZ 85007.	Incomplete applications will not be processed.
	Department of Revenue, 1600 W Monroe, Phoenix AZ 85007.	All required information is designated with asterisk *.
		All required information is designated with asterisk *.

Section A: Taxpayer Information (Please print legibly or type the information on this application.)

1. License Type (Please check all that apply) *

Transaction Privilege Tax (TPT)

Withholding/Unemployment Tax (if hiring employees)

Use Tax

TPT For Cities ONLY

3.Employer Identiﬁcation Number (Required for Employers and Corporations) or Social Security Number *

2. Type of Ownership

Individual / Sole Proprietorship

Partnership

Limited Liability Company

Limited Liability Partnership

Corporation

State of Inc.

Date of Inc.

Sub-Chapter S Corporation

Association

Trust

Government

Estate

Joint Venture

Receivership

*Tax exempt organizations must attach a copy of the Internal Revenue Service letter of determination.

4.	Legal Business Name / Owner / Employing Unit *

5.	Business or “Doing Business As” Name *	6. Business Phone Number *		7.	Fax Number
		(	)		(	)
8.	Mailing Address (Street, City, State, ZIP code)			9.	Country

10. Email Address

11. Is your business located on an Indian Reservation?

	Yes	If yes,		(See Section H for listing of Reservations)
	No

12. Physical Location of Business (Street, City, State, ZIP code) *

13. County

For additional business locations, complete Section B,

14. Are you a construction contractor? *

	Yes	(See bonding requirements below)
	No

15. Did you acquire all or part of an existing business? *

	Yes	If yes, you must complete the Unemployment Tax Information (Section D)
	No

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 must be issued by a surety company authorized to transact business in Arizona. For more information on bonding, please see the “Taxpayer Bonds” publication.

16. Description of Business (Must include type of merchandise sold or taxable activity or type of employment) *

17. NAICS Code: (Select at least one. Go to www.aztaxes.gov for a			18. Business Classes (Select at least one. See Section I for a listing of
	listing of codes) *			business classes) *
A.		B.	A.		B.

C.		D.	C.		D.

19. Identiﬁcation of Owner (and Spouse if married) Partners, Corporate Ofﬁcers, Members (or Managing Members) or Ofﬁcials of this employing unit

A. Name (Last, First, MI) *

B. Soc. Sec. No. *

C. Title *

D. % Owned *

E. Complete Residence Address *

F. Phone Number *

( )

If the owner, partners, corporate ofﬁcers or combination of partners or corporate ofﬁcers, members and/or managing members own or control more than 50% of another business in Arizona, attach a list of the businesses, percentages owned and unemployment insurance account numbers.

ADOR 74-4002 (12/03)

JT-1/UC-001 (12/03) (Page 2)

Section B: Transaction Privilege Tax (TPT)

Date Business Started in Arizona *

2. Date Sales Began *

3. What is your anticipated annual income for

your ﬁrst twelve months of business? *

TPT Filing Method:

5. Does your business sell tobacco products?

6. Does your business sell new motor vehicle

Cash Receipts

Yes

tires or vehicles?

If yes,

Accrual

Retailer

Distributor

Yes

(You will be required to ﬁle a TR-1.)

Are you a seasonal

If yes, please check the months in which you intend to do business:

ﬁler?

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Yes

Location of Tax Records (Street Address, City, State and ZIP code):

Name of Company or person to Contact

10. Phone Number

(

)

For Additional Locations, complete the following: (If more space is needed, please attach additional sheets)

11. “Doing Business As” Name for this Location

12. Phone Number

(

)

13. Physical Location Address (Do not use PO Box or Route No.)

14. City

15. County

16. State

17. ZIP code

18. “Doing Business As” Name for this Location

19. Phone Number

(

)

20. Physical Location Address (Do not use PO Box or Route No.)

21. City

22. County

23. State

24. ZIP code

Section C: Withholding Information (Complete only if registering for withholding/unemployment tax)

Are you liable for Federal Unemployment tax?

2. Are individuals performing services for you excluded from withholding or unemployment

Yes

If yes, what was the ﬁrst year

tax?

Yes

If yes, please explain:

of liability?

Do you have an IRS writing that grants an exclusion

4. Date Employees

5. Do you have or have you previously had an

from federal unemployment tax?

First Hired? *

Arizona State Tax Number?

Yes

YES

If yes, Business Name

If yes, please attach a copy of the letter.

Unemployment Number

Check here if you want to cancel the existing number

Record of Arizona wages paid by calendar quarters for current and preceding calendar years.

YEAR

1ST QUARTER

2ND QUARTER

3RD QUARTER

4TH QUARTER

Weekly record of number of persons performing services in Arizona for current and preceding calendar years.

YEAR

JANUARY

FEBRUARY

MARCH

APRIL

MAY

JUNE

YEAR

JULY

AUGUST

SEPTEMBER

OCTOBER

NOVEMBER

DECEMBER

ADOR 74-4002 (12/03)

JT-1/UC-001 (12/03) - (Page 3)

Section D: Unemployment Tax Information (Complete only if registering for withholding/unemployment tax)

I.If you acquired all or part of an existing Arizona business, please complete this section

1. Date Acquired:	2. Acquired:		3. Acquired by:	If other, please explain:
		Part	Purchase
		Part	Lease
		All	Lease
		All	Other
			Other
Previous Owners Information

4. Name(s) of Previous Owners:

5. Business Name of Previous Owners:

6. Current Street Address of Previous Owners:

7. City

8. State

9. ZIP code

10. Current Telephone Number of Previous Owners:

11. Unemployment Number of Previous Owners:

Voluntary Election of Unemployment Tax Coverage

12.The undersigned, on behalf of the employing unit, voluntarily elects beginning January 1 of the current calendar year or the date employment started if later and continuing for not less than two full calendar years to:

A. Become an employer subject to Title 23, Chapter 4, Arizona Revised Statutes, to the same extent as all other employers and extend unemployment tax coverage to my employees although not mandatory.

B. Extend coverage to all employees performing services excluded from coverage as shown in Section C, Question 2.

13. Send unemployment claims to a different address?		14. Contact Name	15. Contact Phone Number
Yes
No	If yes, please complete lines 14-20		(	)

16.Business Name

17.Street Address

18.	City		19. State	20.	ZIP code

21.	Will payroll be paid by another company?	22. Contact Name		23.	Contact Phone Number

Yes

No		If yes, please complete lines 22-30				(	)
24.	Business Name of Payroller			25. Effective Date/Date Payroll First Paid by		26. Employer Account Number
				Another Company		of Payroller

27.	Street Address of Payroller

28.	City				29. State	30.	ZIP code

31.	Will employees be leased from another company?		32. Contact Name			33.	Contact Phone Number

Yes

No		If yes, please complete lines 32-40		(	)
34.	Business Name of Leasing Company		35. Effective Date/Date Employees First	36. Employer Account Number
			Leased by Another Company	of Leasing Company

37.	Street Address of Leasing Company

38. City

39. State

40. ZIP code

Section E: Signature(s) By Individuals legally responsible for the business (required)

This application must be signed by either a sole owner, two partners, two corporate ofﬁcers, members and/or managing members, the trustee, receiver or personal representative of an estate.

UNDER PENALTY OF PERJURY I (WE) DECLARE THAT THE INFORMATION ON THIS DOCUMENT IS TRUE AND CORRECT.

Type or Print Name

Title

Signature

Date

Type or Print Name

Title

Signature

Date

THIS APPLICATION MUST BE COMPLETED, SIGNED AND RETURNED AS PROVIDED BY ARS § 23-722 Equal Opportunity

Employer/Program This document available in alternative formats by contacting the UI Tax Ofﬁce.

ADOR 74-4002 (12/03)

JT-1/UC-001 (12/03) (Page 4)

Section F: AZTaxes.gov Security Administrator Information

Please complete this section if you would like online access to www.aztaxes.gov.

1.	Last Name	2.	First Name

3.	Title	4.	Social Security Number

5.	Email Address	6.	Phone Number

Section G: Program Cities / License Fees

Below is a list of cities and towns licensed by the Arizona Department of Revenue. For cities not listed below, please contact the cities directly.

City/Town

Code

Fee

No. of

Total

City/Town

Code

Fee

No. of

Total

City/Town

Code

Fee

No. of

Total

Loc

Apache Junction

2.00

Goodyear

5.00

Sahuarita

5.00

Benson

5.00

Guadalupe

2.00

San Luis

2.00

Bisbee

1.00

Hayden

5.00

Sedona

2.00

Buckeye

2.00

Holbrook

1.00

Show Low

2.00

Bullhead City

2.00

Huachuca City

2.00

Sierra Vista

1.00

Camp Verde

2.00

Jerome

2.00

Snowﬂake

2.00

Carefree

10.00

Kearny

2.00

Somerton

2.00

Casa Grande

2.00

Kingman

2.00

South Tucson

2.00

Cave Creek

20.00

Lake Havasu

5.00

Springerville

5.00

Chino Valley

2.00

Litchﬁeld Park

2.00

St. Johns

2.00

Clarkdale

2.00

Mammoth

2.00

Superior

2.00

Clifton

2.00

Marana

5.00

Surprise

10.00

Colorado City

2.00

Maricopa

2.00

Taylor

2.00

Coolidge

2.00

Miami

2.00

Thatcher

2.00

Cottonwood

2.00

Oro Valley

12.00

Tolleson

2.00

Douglas

5.00

Page

2.00

Tombstone

1.00

Duncan

2.00

Paradise Valley

2.00

Wellton

2.00

Eagar

10.00

Parker

2.00

Wickenburg

2.00

El Mirage

2.00

Patagonia

25.00

Willcox

1.00

Eloy

10.00

Payson

2.00

Williams

2.00

Florence

2.00

Pima

2.00

Winkelman

2.00

Fountain Hills

2.00

Pinetop/Lakeside

2.00

Winslow

10.00

Fredonia

10.00

Prescott Valley

2.00

Youngtown

10.00

Gila Bend

2.00

Quartzsite

2.00

Yuma

2.00

Gilbert

2.00

Queen Creek

2.00

Globe

2.00

Safford

2.00

Total of City Fees:

Please Note: City fees are subject to change

State Fees $12.00 X Number of Locations:

occasionally. You will be billed for the difference.

TOTAL Fees:

Section H: Indian Reservation Codes

Indian Reservation

Code

Indian Reservation

Code

Indian Reservation

Code

Indian Reservation

Code

(County)

Ak-Chin (Pinal)

PNA

Hopi (Coconino)

COJ

Pascua-Yaqui (Maricopa)

MAN

Tohono O’Odham (Pinal)

PNT

Cocopah

YMB

Hopi (Navajo)

NAJ

Pascua-Yaqui (Pima)

PMN

Tonto Apache (Gila)

GLU

Colorado River (La Paz)

LAC

Hualapai (Coconino)

COK

Salt River Pima-Maricopa (Mar.)

MAO

White Mtn Apache (Apache)

APD

Fort McDowell-Yavapai (Mar.)

MAE

Hualapai (Mohave)

MOK

San Carlos (Apache (Gila)

GLP

White Mtn Apache (Gila)

GLD

Fort Mohave (Mohave)

MOF

Kaibab-Paiute (Coconino)

COL

San Carlos Apache (Graham)

GRP

White Mtn Apache (Graham)

GRD

Fort Yuma-Quechan (Yuma)

YMG

Kaibab-Paiute (Mohave)

MOL

San Carlos Apache (Pinal)

PNP

White Mtn Apache (Navajo)

NAD

Gila River (Maricopa)

MAH

Navajo (Apache)

APM

San Juan Southern Paiute

COQ

Yavapai Apache (Yavapai)

YAW

Gila River (Pinal)

PNH

Navajo (Coconino)

COM

Tohono O’Odham (Maricopa)

MAT

Yavapai Prescott (Yavapai)

YAX

Havasupai (Coconino)

COI

Navajo (Navajo)

NAM

Tohono O’Odham (Pima)

PMT

ADOR 74-4002 (12/03)

JT-1/UC-001 (12/03) (Page 5)

Section I: Business Classes

Business Class	Code	Business Class	Code	Business Class	Code	Business Class	Code

Mining - Nonmetal	002	Commercial Lease	013	Use Tax - Utilities	026	Jet Fuel Tax	049
Utilities	004	Personal Property Rental	014	Rental Occupancy Tax	028	Jet Fuel Use Tax	051
Communications	005	Contracting - Prime	015	Use Tax Purchases	029	Rental Car Surcharge	053/055
						Jet Fuel Tax > 10 million
Transporting	006	Retail	017	Use Tax from Inventory	030	gallions	056
		Service -
Private Car - Pipeline	007/008	Metalliferous Mining	019	Telecommunications Devices	033	Use Tax Direct Payments	129
		Serverance - Timbering		911 Wireless		911 Wireline
Publication	009	Ponderosa	021	Telecommunications	036	Telecommunications	131
		Serverance - Timbering				Rental Car Surcharge -
Job Printing	010	Other	022	Contracting - Owner Builder	037	Stadium	153
		Recreational Vehicle
Restaurants and Bars	011	Surcharge	023	Municipal Water	041
Amusement	012	Transient Lodging	025	Membership Camping	047

INSTRUCTIONS FOR ARIZONA JOINT TAX APPLICATION

IMPORTANT: You must complete each of the following sections or your application will be returned

USE THIS APPLICATION TO:

•License New Business: A new business with no previous owners.

•Change Ownership: If acquiring or succeeding to all or part of an existing business or changing business entity (sole owner to corporation, etc.).

If you need to update a license, add a business location, or make other changes: Request an update card or provide a written notiﬁcation of the change (a form is not necessary). Please include fees of $12 per location plus applicable city fee(s).

Section A: TAXPAYER INFORMATION 1. LICENSE TYPE

Transaction Privilege Tax (TPT): Anyone involved in an activity taxable under the TPT statutes must apply for a TPT License before engaging in business.

For TPT, you are required to obtain and display a separate license certiﬁcate for each business or rental location. This may be accomplished in one of the following ways:

Each location may be licensed as a separate business with a separate license number for purposes of reporting transaction privilege and use taxes individually. Therefore a separate application is needed for each location.

Multiple locations may be licensed under a consolidated license number, provided the ownership is the same, to allow ﬁling of a single tax return. If applying for a new license, list the various business locations as instructed below. If already licensed and you are adding locations, do not use this application to consolidate an existing license. Please submit update form.

Withholding & Unemployment Taxes: Employers paying wages or salaries to employees for services performed in the State must apply for a Withholding number & Unemployment number.

Use Tax: Out-of-state vendors (that is, vendors with no Arizona location) making direct sales into Arizona must obtain a Use Tax Registration Certiﬁcate. In-state vendors making out-of-state purchases for their own use (and not for resale) must also obtain the Use Tax Registration Certiﬁcate.

TPT for cities only: This type of license is needed if your business activity is subject to city TPT that is collected by the state, but the activity is not taxed at the state level. Many of the larger cities in Arizona administer and collect their own privilege taxes. Please contact those cities directly to obtain information regarding licensing requirements.

2.TYPE OF OWNERSHIP

Check as applicable. A corporation must provide the state and date of incorporation.

3.Enter your Federal Employer Identiﬁcation number.

•Taxpayers are required to provide their taxpayer identiﬁcation number (TIN) on all returns and documents. A TIN is deﬁned as the federal employer identiﬁcation number (EIN), or social security number (SSN) depending upon how income tax is reported. Employers and Corporations must provide their federal EIN. A penalty of $5 will be assessed by the Department of Revenue for each document ﬁled without a TIN.

•If you have an IRS writing that grants an exclusion from Federal Unemployment Taxes, attach a copy.

4.Enter the Legal Business Name of the Owner or Employing Unit (Name of corporation as listed in its articles of incorporation, or individual & spouse, or partners, or organization owning or controlling the business)

5.Enter the name of the Business/DBA (doing business as) name, if same as above, enter “same.”

6.Enter the business telephone number including area code.

7.Enter the fax number including area code.

8. and 9.

Enter mailing address where all correspondence is to be sent. You may use your home address, corporate headquarters, or accounting ﬁrm’s address, etc. If mailing address differs for licenses (for instance withholding and unemployment insurance), please use cover letter to explain.

10.Enter the e-mail address (option) for the business or contact person.

11.See section H for listing of reservation codes if your business is located on an Indian Reservation.

12.and 13.

Enter the physical location of business including county.

14.If you are a construction contractor, read the bonding requirements carefully.

15.If you answered yes, you must complete Section D.

16.Describe the major business activity: principal product you manufacture, commodity sold, or services performed. Your description of the business is very important because it determines your transaction privilege tax rate and provides a basis for state economic forecasting.

17.Enter the North American Industries Classiﬁcation System (NAICS) code identiﬁed for your business activity.

ADOR 74-4002 (12/03)

JT-1/UC-001 (12/03) (Page 6)

18.Enter the applicable business classes based on your activity. See Section I for listing of business classes.

19.Identify the owners of the business. Enter as many as applicable; attach a separate sheet if additional space is needed.

Section B: TRANSACTION PRIVILEGE TAX (TPT)

1.Enter the date the business started in arizona.

2.Enter date sales began in Arizona, or estimate when you plan to begin selling in Arizona.

3.Enter the amount of Transaction Privilege Tax income you can reasonable expect to generate in your ﬁrst twelve months of business. You will be set up for monthly ﬁling unless your anticipated annual income will result in a tax liability of less than $1,250 which may qualify for a quarterly ﬁler.

4.Cash/Accrual Methods: Cash method requires the payment of tax based on sales receipts actually received during the period covered on the tax return. When ﬁling under the accrual method, the tax is calculated on the sales billed rather than receipts.

5.Complete as indicated.

6.Sellers of new motor vehicles and motor vehicle tires in the state, for on- road use, are required to report and pay waste tire fees to the Department of Revenue. By checking the box, you will receive form TR-1 on a quarterly basis.

7.If your business is seasonal or a transient vendor, indicate the months in which you intend to do business.

8. 9. and 10.

Indicate the physical location of your tax records, the contact person and their phone number.

11. through 24.

If you have additional business locations, complete this section. If more space is necessary, attach additional sheets.

Section C: WITHHOLDING INFORMATION

1.Indicate whether you are liable for Federal Unemployment Tax and the ﬁrst year of your liability

2.If you have individuals excluded from withholding or unemployment tax, please explain why.

3.Indicate whether you have an IRS writing for exclusion from federal unemployment tax..

4.Enter the date employees were ﬁrst hired in Arizona.

5.If you have or had an Arizona state tax number, provide requested information.

6.Enter the average number of employees and total gross wages paid for each quarter the business operated.

7.Enter the number of persons performing services each week the business operated.

Section D: UNEMPLOYMENT TAX INFORMATION

WHAT IS A SUCCESSOR EMPLOYER?

When you acquire all or part of a business, which required to pay unemployment taxes in Arizona, you are a “successor” for unemployment tax purposes. As a successor, you are immediately liable for unemployment taxes regardless of the amount of wages you pay or the number of workers you employ.

As a successor, you may also take into account wages paid by the former owner in determining the amount of wages on which you must pay taxes during the year in which you acquired the business. For example, if the former owner has paid wages in excess of $7,000 to a worker you continue to employ, you will not have to pay taxes on any additional wages you pay this worker in the year you acquire the business.

ACQUISITION OF ALL OF AN EXISTING ARIZONA BUSINESS

When you acquire an entire business and continue its operation, you are assigned the tax rate and experience rating account of the former owner. The experience rating account includes the record of wages and taxes previously paid. Therefore, any unemployment beneﬁts awarded based on wages paid by the former owner, may be charged to your account.

Additionally, you may be liable for taxes unpaid by the former owner. When acquiring a business, consider whether any unemployment taxes remain unpaid by the seller.

ACQUISITION OF A PART OF AN EXISTING ARIZONA BUSINESS

If you acquire a PART of a business and continue to operate it, you are not automatically assigned the tax rate and experience rating account of the former owner. To apply for a portion of the account and its corresponding tax rate, you must ﬁle an “Application & Agreement for Severable Portion Experience Rating Transfer” (UC-247) within 180 days of acquiring the business. The former owner must agree and provide payroll information for the portions of the business acquired and retained. Your account may then be charged for a portion of the unemployment beneﬁts paid to the former owners’ employees. The application form is available online at: www.de.state.az.us/esa/uitax/taxform.asp. or you may call (602) 248-9101 to obtain an application.

1. through 3.

Enter the date acquired, whether all or part, and how you acquired.

4. through 11.

Enter the previous owner’s information, name, business name, current street address, telephone number, and unemployment number of previous owner.

12.Voluntary Election of Unemployment Tax Coverage

Complete and sign this portion of the application ONLY if you wish to provide unemployment coverage to your employees, and you believe you are not REQUIRED to provide coverage. Refer to the “Employers Handbook” (available online at www.de.state.az.us/esa/uitax/emp.asp. or “Guide to Arizona Employment Tax Requirements.”

13. through 20.

Complete this section if you would like to receive unemployment claims at a different address.

21. through 30.

Complete this section if your payroll will be paid by another company.

31. through 40.

Complete this section if your employees are leased from another company.

Section E: SIGNATURES

The application must be signed only by individuals legally responsible for the business, not agents or representatives.

Section F: AZTaxes.gov SECURITY ADMINISTRATOR INFORMATION 1. THROUGH 6.

Complete this section if you would like to designate a security administrator for our online service center www.aztaxes.gov. The authorized individual will have full access to tax account information including add/delete users, view tax account information, ﬁle tax returns, and remit tax payments on behalf of the business identiﬁed in Section A. The name and e-mail address of the administrator are required for registration.

Section G: PROGRAM CITIES / LICENSE FEES

There are no fees for Withholding, Unemployment, or Use Tax registrations. To calculate the fees for TPT licenses, calculate the State fees by multiplying the number of locations in the state by $12. To calculate the city fees, use the listing of program cities in Section G. First, indicate the number of businesses or physical locations for each of the cities for which the Department of Revenue licenses and collects. Then multiply by the city fee for each city in which you will do business. Add the columns to determine the total city fees. Fill in the totals for state fees and city fees on the application form and total to determine the amount due. Make checks payable to the Arizona Department of Revenue. Be sure to return the city fees sheet with your application. To obtain licensing for cities not listed on the form, please contact the city directly.

Section H: INDIAN RESERVATION CODES

If your business is located on an Indian Reservation, select appropriate code from this table and indicate on Section A-11.

Section I: BUSINESS CLASSES

Select appropriate business classes based on your business activities. You must indicate at least one business class on Section A-18.

ADOR 74-4002 (12/03)

Question	Answer
Form Name	Arizona Form Jt 1 Uc 001
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	Mohave, Mtn, aztaxes, arizona joint tax application fillable

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