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ARKANSAS INDIVIDUAL INCOME TAX RETURN

1999 AR1000NR

Nonresident and Part Year Resident

Dept. Use Only

Jan 1 - Dec 31, 1999 or fiscal year ending

, 19

FIRST NAME AND INITIAL (List both if applicable)

LAST NAME(S) (See Instructions)

YOUR SOCIAL SECURITY NUMBER

PRESENT ADDRESS - NUMBER AND STREET, APARTMENT OR RURAL ROUTE

SPOUSE SOCIAL SECURITY NUMBER

CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE

HOME TELEPHONE:

WORK TELEPHONE:

NONRESIDENT: (List State of residence)

PART YEAR RESIDENT: (Time of residency in AR)

ATTACH A COPY OF YOUR COMPLETE FEDERAL RETURN

MARRIED FILING SEPARATELY ON THE SAME RETURN:

SINGLE: (Or widowed before 1999 or divorced at end of 1999)

MARRIED FILING SEPARATELY ON DIFFERENT RETURNS:

MARRIED FILING JOINT: (Even if only one had income)

Enter spouse’s name here and SSN above _______________

HEAD OF HOUSEHOLD: (See Instructions)

QUALIFYING WIDOW(ER): with dependent child.

If the qualifying person is your child but not your dependent,

Year spouse died:(see instructions) _____________________

enter this child’s name here: __________________________

HAVE YOU FILED A FEDERAL EXTENSION?

Check this box if you have filed an Automatic Federal Extension Form 4868. (See Instructions)

7A.

YOURSELF

65 or OVER

65 SPECIAL

BLIND

DEAF

HEAD OF HOUSEHOLD/

QUALIFYING WIDOW(ER)

SPOUSE

65 or OVER

65 SPECIAL

BLIND

DEAF

X $20

7B. First name(s) of dependents:

(Do not list yourself or spouse)

Multiply number of boxes checked from Line 7A ..........

____________________________________________

X $20

Multiply number of dependents from Line 7B ................

7C. First name of developmentally disabled child(ren):

(See Instructions)

Multiply number of developmentally disabled

____________________________________________

X $500 =

children from Line 7C .......................................................

7D.TOTAL PERSONAL CREDITS: (Add Lines 7A, 7B and 7C. Enter total here and on Line 43). ............................................ 7D

B Spouse Income

C Arkansas Income

Your Income

ROUND ALL INCOME FIGURES TO WHOLE DOLLARS

Status 4 Only

Only

8. Wages, salaries, tips, etc.: ............................................................................................ 8

9A. U. S. military compensation pay:

(Your/joint gross amount).

Less $6,000

9B. U. S. military compensation pay:

(Spouse gross amount).

Less $6,000

10. Minister’s income: Gross $ ______________ Less rental value $ _______________ 10

11. Interest income: (If over $400.00, attach page AR4). .................................................... 11

12. Dividend income: (If over $400.00, attach page AR4). .................................................. 12

13. Alimony and separate maintenance received: .............................................................. 13

14. Business or professional income: (Attach Federal Schedule C or C-EZ). ..................... 14

15. Capital gains/losses from stocks, bonds, etc.: (See Instr. Attach Federal Schedule D). 15

16. Other gains or (losses): (Attach Federal Form 4797). ................................................... 16

17. IRA distributions and fully taxable annuities: ................................................................. 17

18A. Employer sponsored pension plan:

18A

(Your/joint gross amount)

Less $6,000

18B. Employer sponsored pension plan:

18B

(Spouse gross amount) ...

Less $6,000

DO NOT ADJUST LINES 18A AND 18B FOR COST RECOVERY. (See Instructions).

19. Rents, royalties, partnerships, estates, trust, etc.: (Attach Federal Schedule E). .......... 19

20. Farm Income: (Attach Federal Schedule F). ................................................................. 20

21. Other income: (List type and amount. See Instructions). .............................................. 21

22. TOTAL INCOME: (Add Lines 8 through 21). ................................................................. 22

23. Payments to

IRA and

MSA: (See Instructions for limitations). ...................... 23

24. Deduction for interest paid on student loans: (See Instructions). .................................. 24

25. Contributions to Intergenerational Trust: (See Instructions). ......................................... 25

26. Moving expenses

(Attach Federal Form 3903 or 3903F). ............................................. 26

27. Self-employed health insurance deduction: (See Instructions for limitation). ................ 27

28. KEOGH and Self-employed SEP and Simple Plans: .................................................... 28

0 0

29. Forfeited interest penalty for premature withdrawal: ..................................................... 29

30. Alimony/separate maintenance paid to: Name _____________ SSN: ____________ 30

31. Border city exemption: (Attach Form AR - TX). ............................................................. 31

32. Support for permanently disabled child: (Attach Form AR1000DC). ............................. 32

33. TOTAL ADJUSTMENTS: (Add Lines 23 through 32). ................................................... 33

34. ADJUSTED GROSS INCOME: (Subtract Line 33 from Line 22). .................................. 34

Page NR1 (R 8/99)

Form Ar1000nr - Arkansas Individual Income Tax Return Nonresident And Part Year Resident - 1999

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