Instructions for filing combined Notice of Withdrawal and Withdrawal Request form. Complete one of the following forms to request a cancellation of an Arizona combined wage claim.Static forms need to be printed and completed manually. If you choose to withdraw your appeal or complaint from the Arizona State Personnel Board, please complete the form below. The employee should complete Form A-4 electing their withholding percentage and return it to the employer. Out-of-State Resident Working for an Arizona Business. Complete the top employee authorization portion of the Employer Affidavit; and,; Submit the form via mail to: Arizona Department of Revenue. If you are a current city employee, you may request reinstatement to any former positions that are at a higher salary range than your current position. A PEHP account can be used to reimburse your qualified medical care expenses or those of your spouse or dependents after severance from employment. All forms are in PDF format and are fillable (you can type in them).