APS 2013 Annual Report Download - page 249

Pinnacle West Capital Corporation
RESTRICTED STOCK UNIT AWARD
ELECTION FORM
(applies to Award Agreement dated / / )
INFORMATION ABOUT YOU
Last First Middle Initial Employee ID#
1. PAYMENT ELECTION
In accordance with the terms of the Pinnacle West Capital Corporation 2012 Long-Term Incentive Plan and pursuant to Section 4(b) of the Award Agreement, I
hereby elect to receive payment for the Restricted Stock Units and Dividend Equivalents that vest on the dates set forth below in the following form (place an
“X” in the “Stock” column or in the “50% Cash/50% Stock” column for each of the years and types of Awards set forth below):
Restricted Stock Units and Dividend Equivalents
Vesting Date Stock
50% Cash/
50% Stock
/ / ¨ ¨
/ / ¨ ¨
/ / ¨ ¨
/ / ¨ ¨
2. TAX WITHHOLDING ELECTION
I hereby elect to satisfy any tax withholding obligation associated with my receipt of Stock or Stock and cash in exchange for my Restricted Stock Units and
Dividend Equivalents in the following form (place an “X” in the “Check” column or in the “Withholding” column):
Check Withholding
(I will write a check for my taxes that are due and deliver it to the Company
within one (1) day of the release date of my Stock or cash payment)
(The Company should withhold
shares of my Stock or cash payment
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 ,
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