Form Ar941m - State Of Arkansas Monthly Withholding Report
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1FOR DEPARTMENT USE ONLY
STATE OF ARKANSAS
AR941M Monthly Withholding Report
Make your check payable to:
Department of Finance & Administration
Zip Key
Period Covered
Due Date
ID Number
If you are no longer withholding Arkansas tax,
Address Change
Reason Closed
indicate the date you stopped. (MM/DD/YY)
(See back for instructions)
1.
Tax Withheld
Business Name: __________________________________
2.
Adjustments
Address: ________________________________________
3.
Tax Due
_______________________________________________
4.
Interest
_______________________________________________
5.
Penalty
_______________________________________________
6.
Amount Paid
DO NOT MARK IN BOXES A, B, C, OR D. - FOR OFFICE USE ONLY
0
A.
B.
C.
D.
I declare under penalties of purjury that I have examined this return and to the best of my knowledge and
belief, it is a true, correct and complete return.
Signature _______________________________________________ Date _______________ Telephone _________________
INSTRUCTIONS
PERIOD COVERED AND DUE DATE
TAX WITHHELD
Enter the reporting period and due date for this coupon. You
Enter the total amount of Arkansas Income Tax withheld for
can only report on period per coupon. All new accounts are
this reporting period.
reported and paid on the 15
th
of the following month. There is
ADJUSTMENTS
no quarterly filing.
Enter any adjustment to be deducted from the amount you will
ID NUMBER
pay for this period. You must include a detailed explanation of
Enter you Federal Identification Number.
any adjustment you list.
ZIP KEY
TAX DUE
Enter your 5-digit Zip Code.
Subtract the adjustment amount from tax withheld.
DATE CLOSED
INTEREST AND PENALTY
Enter the day the business closed or stopped withholding Ar-
List any Interest or Penalty amounts included with this report
kansas taxes. This will close your withholding account with the
if your report is made past the due date.
State of Arkansas until you re-register your business for with-
AMOUNT PAID
holding purposes.
Add the Tax Due, Interest and Penalty amounts.
REASON CLOSED
MAKE YOUR CHECK OR MONEY ORDER PAYABLE TO:
Enter the number of the appropriate reason.
1. Business discontinued.
Department of Finance and Administration
2. Business transferred to successor.
MAIL TO:
3. Change in organization.
4. Discharged all employee but continuing business.
P.O. Box 9941, Little Rock, Arkansas 72203-9941
5. Other. (Specify): __________________________
__________________________
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