INSTRUCTIONS: ARIZONA LUMP SUM DISTRIBUTION ELECTION FORM FOR REFUNDS (Form U3)

Terminated Arizona public safety personnel, corrections officers or elected officials enrolled in their state's retirement funds for such employees should file a form U3 if requesting a refund in lump sum form from these funds if any of these monies are taxable. This document can be obtained from the website maintained by the Elected Officials' Retirement Fund of the State of Arizona.

Arizona Lump Sum Distribution Election Form For Refunds U3 Step 1: On the first line, enter your name.

Arizona Lump Sum Distribution Election Form For Refunds U3 Step 2: On the second line, enter your Social Security number.

Arizona Lump Sum Distribution Election Form For Refunds U3 Step 3: On the third line, enter your date of termination.

Arizona Lump Sum Distribution Election Form For Refunds U3 Step 4: Three options are listed regarding your refund. Sign and date section A if you wish to receive full payment of the refund minus any applicable withholding described in the Special Tax Notice sent along with this election form.

Arizona Lump Sum Distribution Election Form For Refunds U3 Step 5: If you wish to receive a direct deposit of only the taxable portion of your refund, enter the name of the financial institution which will be receiving this direct deposit on the first line of Section B. Sign and date the second and third blank lines to confirm you will be receiving the non-taxable portion directly.

Arizona Lump Sum Distribution Election Form For Refunds U3 Step 6: Section C is for those who wish to have a flat amount of their distribution paid directly to a financial institution for deposit, while having the rest of the taxable amount minus 20% in federal withholding paid directly to themselves. If this is the case, enter the dollar amount to be distributed in the first line, the financial institution's name in the second line, and sign and date the last two blank lines.

Arizona Lump Sum Distribution Election Form For Refunds U3 Step 7: If Section B or C, a representative of the financial institution must complete the agreement of depository trustee form on the second page.

Arizona Lump Sum Distribution Election Form For Refunds U3 Step 8: Mail the form to the address at the bottom of the second page.