Form Ar1000nr - Arkansas Individual Income Tax Return - 2012 Page 2
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NR2
(A)
Your/Joint
(B) Spouse’s Income
(C)
Arkansas
Status 4 Only
Income Only
Income
TOTAL INCOME: (From Line 21, Columns A through C)..................................
00
00
00
22.
22.
TOTAL ADJUSTMENTS: (Attach Form AR1000ADJ)....................................
00
00
00
23.
23.
00
00
00
ADJUSTED GROSS INCOME: (Subtract Line 23 from Line 22)....................
24.
24.
Select tax table: (Check the appropriate box)
LOW INCOME Table
REGULAR Table
25.
If you qualify for the Low Income Tax Table, enter zero (0) on Line 25A. If not, then:
}
Itemized Deductions (See Instructions, Line 25)
Enter
(B) Spouse’s Income
(A)
Your/Joint
the larger
OR
Status 4 Only
Income
00
00
Standard Deduction (See Instructions, Line 25) .........................25
of your:
25
00
00
NET TAXABLE INCOME: (Subtract Line 25 from Line 24) Columns A&B ...................26
26.
26
00
00
TAX: (Enter tax from tax table) ..........................................................................................27
27.
27
00
28.
Combined tax: (Add amounts from Lines 27A and 27B) .................................................................................................28
00
29.
Enter tax from Lump Sum Distribution Averaging Schedule:
(Attach AR1000TD)
.......................................................... 29
00
30.
IRA and qualified plan withdrawal and overpayment penalties:
(Attach federal Form 5329, if required)
........................ 30
00
31.
TOTAL TAX: (Add Lines 28 through 30) ......................................................................................................................31
00
32.
Personal Tax Credit(s): (Enter total from Line 7D) .............................................................32
00
33.
Child Care Credit:
(20% of federal credit allowed; Attach federal Form 2441)
..........................33
00
34.
Other Credits:
(Attach AR1000TC)
.....................................................................................34
TOTAL CREDITS: (Add Lines 32 through 34) .............................................................................................................35
35.
00
NET TAX: (Subtract Line 35 from Line 31. If Line 35 is greater than Line 31, enter 0) ................................................ 36
00
36.
00
36A. Enter the amount from Line 24, Column C: ............................................................... 36A
00
36B. Enter the total amount from Line 24, Columns A and B: ......................................... 36B
36C. Divide Line 36A by 36B: (See Instructions) ...................................................................................................................
36C
00
36D. APPORTIONED TAX LIABILITY: (Multiply Line 36 by Line 36C) .........................................................................
36D
00
37.
Arkansas income tax withheld:
[Attach state copies of W-2 and/or 1099R Form(s)]
.........37
00
38.
Estimated tax paid or credit brought forward from 2011: ....................................................
38
00
39.
Payment made with extension: (See Instructions) .............................................................39
40.
AMENDED RETURNS ONLY
- Previous payments (see instructions): .............................40
00
41.
Early childhood program: Certification Number:
00
(20% of federal credit; Attach federal Form 2441 and Form AR1000EC)
41
................................
TOTAL PAYMENTS: (Add Lines 37 through 41) .........................................................................................................42
00
42.
00
43.
AMENDED RETURNS ONLY
- Previous refund (see instructions): ............................................................................... 43
00
44.
Adjusted Total Payments (Subtract Line 43 from Line 42)...............................................................................................44
00
AMOUNT OF OVERPAYMENT/REFUND: (If Line 44 is greater than Line 36D, enter difference) ......................... 45
45.
46.
Amount to be applied to 2013 estimated tax: .....................................................................46
00
47.
Amount of Check-off Contributions:
(Attach Schedule AR1000-CO)
.................................47
00
AMOUNT TO BE REFUNDED TO YOU: (Subtract Lines 46 and 47 from Line 45) ............................. REFUND 48
00
48.
49.
AMOUNT DUE: (If Line 44 is less than Line 36D, enter difference; If over $1,000, see instructions) ..... TAX DUE 49
00
50A.
UEP: Attach Form AR2210 or AR2210A. If required, enter exception in box
50A
Penalty 50B
00
50C.
Add Lines 49 and 50B. Attach Form AR1000V to check or money order payable in U.S. Dollars to “Dept. of Finance
.............. TOTAL DUE 50C
and Administration”. Include your SSN on payment. To pay by credit card, see instructions
00
51.
Amount of income not subject to Arkansas tax from AR4, Part III:
May the Arkansas Revenue Agency discuss
this return with the preparer shown below?
Yes
No
FOR MAILING ADDRESSES SEE PAGE 2 OF INSTRUCTIONS
PLEASE SIGN HERE:
Under penalties of perjury, I declare that I have examined this return and accompanying schedules
and statements, and to the best of my knowledge and belief, they are true, correct and complete. Declaration of preparer (other
than taxpayer) is based on all information of which preparer has any knowledge.
SIGN HERE
Occupation
Date
Your Signature
Home Telephone:
Spouse’s Signature
Occupation
Date
Work Telephone:
Paid Preparer’s Signature
ID Number/Social Security Number
For Department Use Only
A
Preparer’s Name
City/State/Zip
Address
Telephone Number
Page NR2 (R 10/4/12)
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