APS 2013 Annual Report Download - page 242
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Pinnacle West Capital Corporation
PERFORMANCE SHARE AWARD
ELECTION FORM
(applies to Award Agreement dated / / )
INFORMATION ABOUT YOU
Last First Middle Initial Employee ID#
TAX WITHHOLDING ELECTION
I hereby elect to satisfy any tax withholding obligation associated with my receipt of Stock pursuant to my Performance Share Award in the following form
(place an “X” in the “Check” column or in the “Stock” column):
Check Stock
(I will write a check for my taxes that are due and deliver it to the Company
within one (1) day of the release of the Stock)
(The Company should withhold shares
of my Stock to cover my taxes)
o o
To the extent permitted by law, I hereby elect Federal tax withholding of:
¨ minimum withholding rate in effect at the time of release (currently 25%);
¨ percent (within the range of 25% and 39.6%): or
¨ maximum withholding rate in effect at the time of a release (currently 39.6%).
PARTICIPANT NAME (PLEASE PRINT)
DATE
PARTICIPANT SIGNATURE
IMPORTANT NOTE: Please complete and return this Election Form to Jennifer Mellegers at Mail Station 9996 by , .
8