Form Ar1036 - Employee Tuition Reimbursement Tax Credit - 2009 Page 2
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2AR1036
State of Arkansas
EMPLOYEE TUITION REIMBURSEMENT TAX CREDIT
Tax Year beginning ______/_______/_______and ending ______/______/______
Name of Entity
FEIN/SSN
SECTION E
Schedule of Tuition Paid or Reimbursed by Employer
Accredited Educational Institution Located within Arkansas
Employee’s Name
Name of Institution
City
Amount Paid
Date Tuition Paid
or Reimbursed
or Reimbursed
(round to whole dollars)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
1. Total Amount Paid or Reimbursed
1.
$
2. Total Tax Credit (Multiply Line 1 X 30%, Enter results here and on Line 11, Page 1, Section C)
2.
$
Page 2
AR1036 Rev 01/09
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