Form Ar1000od - Organ Donor Deduction Individual Income Tax Return

Form Ar1000od - Organ Donor Deduction Individual Income Tax Return - 2005

AR1000OD

2005

STATE OF ARKANSAS

ORGAN DONOR DEDUCTION

Individual Income Tax Return

Taxpayer’s Name:

Taxpayer’s Social Security Number:

Donor’s Name: (If different than taxpayer’s)

Donor’s Relationship to Taxpayer:

Act 668 of 2005 established a deduction of up to $10,000 for unreimbursed expenses incurred by the

taxpayer or one of his dependents related to the donation of an organ (part of a liver, pancreas, kidney,

intestine, lung, or bone marrow) to another human being. The deduction must be claimed for the taxable

year in which the transplantation of the organ occurs. Allowable expenses include travel, lodging, medical

expenses and lost wages that are related to the organ donation. An individual may claim the deduction only

once in his or her lifetime. This deduction does not apply to organs harvested from a deceased donor.

1. Enter total medical expenses incurred in 2005 related to the donation of an organ (part of a liver,

pancreas, kidney, intestine, lung, or bone marrow) to another human being: ............................................

2. Enter total travel expense incurred: ..........................................................................................................

3. Enter total lodging expense incurred: ........................................................................................................

4. Enter total lost wages incurred: ................................................................................................................

5. Total expenses: (Add lines 1 through 4.) ..................................................................................................

6. Maximum allowable deduction: .................................................................................................................

$10,000 00

7. Deduction allowed: (Enter the lesser of Lines 5 or 6 here and on Line 12, AR1000ADJ.) ..........................

PLEASE SIGN: Under penalties of perjury, I declare that the above information is true, correct and

complete.

Taxpayer

Date

AR1000OD (Rev 11/05)

Form Ar1000od - Organ Donor Deduction Individual Income Tax Return - 2005