Form Ar8453- Arkansas Individual Income Tax Declaration - 1999

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1999

AR8453

Arkansas Individual Income Tax Declaration

for Electronic Filing

For the Year January 1 - December 31, 1999

FIRST NAME AND INITIAL

LAST NAME(S)

YOUR SOCIAL SECURITY #

USE

-

-

STATE

PRESENT ADDRESS

SPOUSE SOCIAL SECURITY #

LABEL

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-

OR

CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE

TELEPHONE NUMBER

PRINT

PART 1

TAX RETURN INFORMATION (Whole Dollars Only)

1.

Total Income (Form AR1000, line 22) ............................................................................................................

1

00

2.

Net Tax (Form AR1000, line 52) ...................................................................................................................

2

00

3.

State Income Tax Withheld (Form AR1000, line 53)...........................................................................................

3

00

4.

Refund (Form AR1000, line 58)....................................................................................................................

4

00

5.

Tax Due (Form AR1000, Line 63) ................................................................................................................

5

00

PART 2

DECLARATION OF TAXPAYER

6a.

I consent that my refund be directly deposited as designated in the electronic portion of my 1999 Arkansas income tax return. If I have filed a joint return, this is

an irrevocable appointment of the other spouse as an agent to receive the refund.

6b.

I do not want direct deposit of my refund or I am not receiving a refund.

If I have filed a balance due return, I understand that the State of Arkansas does not receive full and timely payment of my tax liability, I will remain liable for the tax liability

and all applicable interest and penalties. If I have filed a joint Federal and state tax return and my federal return is rejected, I understand my state return will be rejected also.

Under the penalties of perjury, I declare that if the information I have given my ERO and the amounts in Part I above agree with the amounts on the corresponding lines of the

electronic portion of my 1999 Arkansas income tax return. To the best of my knowledge and belief, my return is true, correct, and complete. I consent to my ERO sending my

return, this declaration, and accompanying schedules and statements to the State of Arkansas. I also consent to the State of Arkansas sending my ERO and/or transmitter an

acknowledgement of receipt of transmission and an indication of whether or not my return is accepted, and if rejected, the reason(s) for the rejection. If the processing of my

return or refund is delayed, I authorize the State of Arkansas to disclose to my ERO and/or transmitter the reason(s) for the delay, or when the refund was sent.

Sign

Here

Your Signature

Date

Spouse’s Signature

Date

PART 3

DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER

I declare that I have reviewed the above taxpayer’s return and that the entries on Form AR8453 are complete and correct to the best of my knowledge. If I am only a collector,

I understand that I am not responsible for reviewing the taxpayer’s return; I declare that Form AR8453 accurately reflects the data on the return. I have obtained the taxpayer’s

signature on Form AR8453 before submitting this return to the State of Arkansas, and have provided the taxpayer with a copy of all forms and information to be filed with the

State of Arkansas. If I am also the Paid Preparer, under penalties of perjury I declare that I have examined the above taxpayer’s return and accompanying schedules and state-

ments, and to the best of my knowledge and belief, they are true, correct and complete. This declaration of Paid Preparer is based on all information of which the preparer has

knowledge.

Your SSN or PTIN

Check if

Check

ERO’s

Date

also paid

if self-

-

-

Signature

preparer

ERO’s

employed

Use

Only

______________________________________________________________

Firm’s name

and address

El No.

Under penalties of perjury, I declare that I have examined the above taxpayer’s return and accompanying schedules and statements, and to the best of my knowledge and belief, they

are true, correct and complete. This declaration is based on all information of which I have any knowledge.

Preparer’s SSN or PTIN

Preparer’s

Date

Check

Signature

if self-

-

-

Paid

employed

Preparer’s

Use Only

______________________________________________________________

Firm’s name

and address

El No.

DO NOT MAIL THIS FORM.

AR 8453 (R 11/99)