Form Ar4rr - Withholding Tax Refund Request

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STATE OF ARKANSAS
AR4RR
Withholding Tax Refund Request
FEIN:
_________________________________________________
Mail this form to:
Business Name:
_________________________________________________
Arkansas Individual Income Tax Section
Withholding Branch
Address:
_________________________________________________
P. O. Box 8055
_________________________________________________
Little Rock, AR 72203-8055
(501) 682-7290
_________________________________________________
INSTRUCTIONS
This form must be completed in order for a business to receive a refund of Arkansas withholding tax. A detailed explanation of any changes must
be attached to this form. List the proper amount of taxes withheld, paid and the difference for each reporting period. Total theTAX WITHHELD and
the TAX PAID columns below. If the total tax paid is greater than the total tax withheld, then subtract the total tax withheld amount from the total tax paid
amount and enter the result on the REFUND line at the bottom of this form.
TAX YEAR __________
PERIOD
TAX WITHHELD
TAX PAID
DIFFERENCE
JAN
____________________
____________________
____________________
FEB
____________________
____________________
____________________
MAR
____________________
____________________
____________________
APR
____________________
____________________
____________________
MAY
____________________
____________________
____________________
JUN
____________________
____________________
____________________
JUL
____________________
____________________
____________________
AUG
____________________
____________________
____________________
SEP
____________________
____________________
____________________
OCT
____________________
____________________
____________________
NOV
____________________
____________________
____________________
DEC
_________________________
_________________________
_________________________
_________________________
_________________________
TOTAL TAX WITHHELD
TOTAL TAX PAID
_________________________
REFUND
________________________________________________
_______________________
_______________________
Signature
Date
Telephone Number
AR4RR (R 10/02)

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