Form Ar1036 - Employee Tuition Reimbursement Tax Credit - 2009
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State of Arkansas
AR1036
EMPLOYEE TUITION REIMBURSEMENT TAX CREDIT
FEIN/SSN
Tax Year beginning ______ /_______/_________ and ending
______/_________/________
Name of Entity
NAICS Code
Address
City
State
County
Zip
Telephone Number
OWNERSHIP CLASSIFICATION
(Check only one Box)
4.
Partnership (Complete Section D below)
1.
Sole Proprietorship
5.
Limited Liability Company LLC (Complete Section D below)
2.
Taxable Corporation
3.
Fiduciary
6.
Subchapter S Corporation (Complete Section D below)
ELIGIBILITY CLASSIFICATION
7. Enter Applicable Eligibility Number (Refer to Instructions, Page 2, Item 15)
8. Enter Percentage of Revenue from out-of-state sales
(If Eligibility Number 2, 3, 4B,4C, 8 or 9 entered on Line 7)
%
9. Enter Percentage of retail sales to general public
(If Eligibility Number 2, 3, 5 or 6 entered on Line 7)
%
10. Enter average hourly wages paid (If Eligibility Number 8 or 9 entered on Line 7)
$
ELIGIBLE TAX CREDIT FOR THIS TAX YEAR
11. Total Tax Credit subject to income tax liability limitation (Enter amount from Section E, page 2, line 2)
$
f Ownership Classifi cation box 4, 5 or 6 is checked in Section A, skip lines 12-14 and complete Section D,
NOTE: I
“Allocation of Total Tax Credit for Pass-Through Entity Members.”
12. Entity’s Income Tax Liability for This Tax Year
$
13. Income Tax Liability Limitation (Multiply Line 12 x 25%)
$
14. Eligible Tax Credit available for this Tax Year only (Enter the smaller of Line 11 or Line 13)
$
ALLOCATION OF TOTAL TAX CREDIT FOR PASS-THROUGH ENTITY MEMBERS
NOTE: Each Member’s share of total tax credit subject to 25% income tax liability limitation
Member’s Share of Total
Member’s Name
Percentage
Member’s SSN/FEIN
Tax Credit From Line 11
Of Ownership
$
%
$
%
$
%
$
%
$
%
$
%
$
%
$
%
$
%
AR1036 Rev 01/09
Page 1
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Parent category: Financial