Form Ar1000nr - Arkansas Individual Income Tax Return - 2012
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NR1
2012 AR1000NR
ARKANSAS INDIVIDUAL
INCOME TAX RETURN
CHECK BOX IF
AMENDED RETURN
Nonresident and Part Year Resident
Dept. Use Only
Jan. 1 - Dec. 31, 2012 or fiscal year ending ____________ , 20 ____
PRIMARY NAME
MI
LAST NAME
YOUR SOCIAL SECURITY NUMBER
SPOUSE NAME
MI
LAST NAME
Important
SPOUSE’S SOCIAL SECURITY NUMBER
MAILING ADDRESS
(Number and Street, P.O. Box or Rural Route)
CITY, STATE AND ZIP CODE
Important: You MUST
enter your SSN(s) above
NONRESIDENT:
PART YEAR RESIDENT:
ATTACH A COPY OF YOUR COMPLETE FEDERAL RETURN
(List State of residence)
(Dates Lived in AR)
1.
SINGLE (Or widowed before 2012 or divorced at end of 2012)
4.
MARRIED FILING SEPARATELY ON THE SAME RETURN
2.
MARRIED FILING JOINT (Even if only one had income)
5.
MARRIED FILING SEPARATELY ON DIFFERENT RETURNS
Enter spouse’s name here and SSN above _______________
3.
HEAD OF HOUSEHOLD (See Instructions)
If the qualifying person was your child but not your dependent,
6.
QUALIFYING WIDOW(ER) with dependent child
enter child’s name here: ______________________________
Year spouse died: (See Instructions)_____________________
Check this box if you have filed a state extension
HAVE YOU FILED AN EXTENSION?
or an automatic federal extension
HEAD OF HOUSEHOLD/QUALIFYING WIDOW(ER)
7A.
YOURSELF
65 or OVER
65 SPECIAL
BLIND
DEAF
(Filing Status 3 Only)
(Filing Status 6 Only)
SPOUSE
65 or OVER
65 SPECIAL
BLIND
DEAF
00
X $23 =
Multiply number of boxes checked from 7A................
7B. Dependents
(Do not list yourself or spouse)
First Name
Last Name
Dependent’s Social Security Number
Dependent’s relationship to you
1.
2.
3.
4.
5.
X $23 =
Multiply number of dependents from 7B............
00
7C. First name of individual(s) with developmental disability: (See Instr.)
X $500 =
00
Multiply number of individuals with developmental disabilities from 7C..........
7D. TOTAL PERSONAL TAX CREDITS: (Add Lines 7A, 7B, and 7C. Enter total here and on Line 32).........................7D
00
(C)
Arkansas
(A)
Your/Joint
(B) Spouse’s Income
ROUND ALL AMOUNTS TO WHOLE DOLLARS
Income Only
Income
Status 4 Only
00
00
00
8.
Wages, salaries, tips, etc:
(Attach W-2s)
..................................................................8
Less
00
00
9A.
U. S. Military compensation:
(Your/joint gross amt.)
00
9A
$9,000
Less
00
00
U. S. Military compensation:
9B.
(Spouse’s gross amt.)
00
9B
$9,000
00
00
00
10.
Interest income:
(If over $1,500, attach AR4)
.........................................................10
00
00
00
11.
Dividend income:
(If over $1,500, attach AR4)
.......................................................11
00
00
00
12.
Alimony and separate maintenance received: .......................................................12
00
00
00
13.
Business or professional income:
(Attach federal Schedule C or C-EZ)
................13
00
00
00
14.
Capital gains/(losses) from stocks, bonds, etc:
(See Instr. Attach federal Schedule D)
..14
00
00
00
15.
Other gains or (losses):
(Attach federal Form 4797 and/or 4684 if applicable)
......15
00
00
00
16.
Non-Qualified IRA distributions and taxable annuities:
(Attach All 1099Rs)
...........16
00
17A. Your/Joint Employer pension plan(s)/Qualified
IRA(s):(See Instructions, Attach All 1099Rs)
Less
00
00
00
Gross Distribution
00
Taxable Amount
00
17A
$6,000
17B. Spouse Employer pension plan(s)/Qualified IRA(s):
(Filing Status 4 only)
00
00
00
Less
17B
Gross Distribution
Taxable Amount
00
00
$6,000
00
00
00
18.
Rents, royalties, partnerships, estates, trusts, etc.:
(Attach federal Schedule
E)...... 18
00
00
00
19.
Farm income:
(Attach federal Schedule F)
............................................................. 19
00
00
00
20.
Other income/depreciation differences: (List type and amount. See Instr.) ............ 20
00
00
00
TOTAL INCOME: (Add Lines 8 through 20) ....................................................... 21
21.
Page NR1 (R 10/4/12)
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