Form Ar4p - Employee'S Withholding Exemption Certificate For Pensions And Annuity Payments - State Of Arkansas

STATE OF ARKANSAS

AR4P

Employee’s Withholding Exemption Certificate

For Pensions and Annuity Payments

Type or Print your full name.

Social Security Number

Home address (number and street or rural route)

Claim or identification number (if any) of

your pension or annuity contract

City, state and ZIP

1. CHECK here if you do not want any Arkansas income tax withheld from your pension or annuity. (Do not complete lines 2 through 6) ........ 1

2. CHECK ONE OF THE FOLLOWING and enter amount of exemptions claimed.

No exemptions or dependents claimed. (Enter zero on lines 2, 3 and 4)

Single and you claim yourself. (Enter one exemption)

Married and you claim yourself and your spouse. (Enter two exemptions)

Head of Household, and you claim yourself. (Enter two exemptions) ............................................................................ 2

___________

3. NUMBER OF CHILDREN or DEPENDENTS. (Enter one exemption per dependent) ............................................................................... 3

___________

4. TOTAL EXEMPTIONS. (Add Lines 2 and 3. If no exemptions or dependents are claimed, enter zero) ....................................................... 4

___________

5. Additional amount, if any, you want deducted from each pension or annuity payment. (Enter dollar amount) .............................................. 5 $ __________

6. I qualify for the low income tax rates. (See reverse for details) .................................................................................................................. 6

Please check filing status:

Single

Married Filing Jointly

Head of Household

I certify that the number of exemptions and dependents claimed on this certificate does not exceed the number to which I am entitled.

Signature: _______________________________________________________________________________________ Date: _________________

Instructions for Completing the

Employee’s Withholding Exemption Certificate

1.

GENERALLY, Arkansas income tax withholding applies to the tax-

4.

CHANGES IN EXEMPTIONS – You may file a new certificate at

able part of payments made from pension, profit-sharing, stock bonus,

any time if the number of exemptions INCREASES. You must file a new

annuity, and certain deferred compensation plans; from individual retire-

certificate within 10 days if the number of exemptions previously claimed

ment arrangements (IRAs); and from commercial annuities. The first

by you DECREASES for any of the following reasons:

$6,000 per year of a pension distribution or Qualified traditional IRA dis-

(a) Your spouse for whom you have been claiming an exemption

tribution may be tax exempt. Also, qualified distributions from a Roth IRA

is divorced or legally separated, or claims his or her own exemption on a

are nontaxable and, therefore, not subject to withholding.

separate certificate, or

(b) The support of a dependent for whom you claimed an exemp-

2.

NUMBER OF EXEMPTIONS – Do not claim more than the cor-

tions is expected to be less than half of the total support for the year.

rect number of exemptions. However, if you expect to owe more income

OTHER DECREASES in exemptions, such as the death of a spouse or

tax for the year, you may increase your withholding by claiming a smaller

a dependent, do not affect your withholding until next year, but require

number of exemptions, or you may enter into an agreement with your

the filing of a new certificate by December 1, of the year in which they

payer to have additional amounts withheld. This is especially important if

occur.

you have more than one payer, or if both husband and wife are receiving

5.

Claim additional amounts of withholding tax if desired. This will ap-

payments.

ply most often when you have income other than wages.

3.

DEPENDENTS – To qualify as your dependent, a person must (a)

6.

You qualify for the low income tax rates if your total income from

receive more than 1/2 of their support from you for the year, (b) not be

all sources are as shown below:

claimed as a dependent by such person’s spouse, (c) be a citizen or

(a) Single

$7,800

to $11,400

resident of the United States, and (d) have your home as their principle

(b) Married filing jointly $15,500

to $16,200

residence and be a member of your household for the entire year or be

(c) Head of Household

$12,100

to $16,200

related to you as follows: son, daughter, grandchild, stepson, stepdaugh-

ter, son-in-law or daughter-in-law; Your father, mother, grandparent, step-

For additional information consult your Plan Administrator or:

father, stepmother, father-in-law or mother-in-law; Your brother, sister,

stepbrother, stepsister, half brother, half sister, brother-in-law or sister-

Arkansas Individual Income Tax Section

in-law; Your uncle, aunt, nephew or niece (but only if related by blood),

Withholding Branch

or, an individual (other than your spouse) who, for the taxable year of the

P. O. Box 8055

taxpayer, had the same principal place of abode as the taxpayer and

Little Rock, Arkansas 72203-8055

was a member of the taxpayer’s household.

Once the filing status and number of exemptions are established, use

the Arkansas Withholding Tables to determine the amount of tax to with-

hold from each distribution.

AR4P (R 03/06)