APS 2015 Annual Report Download - page 247

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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
(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)
Stock
(The Company should withhold shares of my
Stock to cover my taxes)
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%);
o ______ percent (within the range of 25% and 39.6%): or
o maximum withholding rate in effect at the time of a release (currently 39.6%).
__________________________________________
PARTICIPANT NAME (PLEASE PRINT)
__________________________________________
PARTICIPANT SIGNATURE
______________________
DATE
IMPORTANT NOTE: Please complete and return this Election Form to _______________ at Mail Station _____ by April 15,
____________.