Form Ar1000nr Draft - Arkansas Individual Income Tax Return Nonresident And Part Year Resident - 2009

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N
2009 AR1000NR
ARKANSAS INDIVIDUAL
INCOME TAX RETURN
Nonresident and Part Year Resident
Dept. Use Only
Jan. 1 - Dec. 31, 2009 or fiscal year ending ____________ , 20 ____
FIRST NAME(S) AND INITIAL(S)
LAST NAME(S)
YOUR SOCIAL SECURITY NUMBER
(List for both spouses if applicable)
(See Instructions)
MAILING ADDRESS
SPOUSE’S SOCIAL SECURITY NUMBER
(Number and Street, P.O. Box or Rural Route)
CITY, STATE AND ZIP CODE
You MUST
Important
enter your
SSN(s) above
NONRESIDENT:
PART YEAR RESIDENT:
ATTACH A COPY OF YOUR COMPLETE FEDERAL RETURN
(List State of residence)
(Dates Lived in AR)
1.
SINGLE (Or widowed before 2009 or divorced at end of 2009)
4.
MARRIED FILING SEPARATELY ON THE SAME RETURN
2.
MARRIED FILING JOINT (Even if only one had income)
5.
MARRIED FILING SEPARATELY ON DIFFERENT RETURNS
Enter spouse’s name here and SSN above _______________
3.
HEAD OF HOUSEHOLD (See Instructions)
If the qualifying person was your child but not your dependent,
6.
QUALIFYING WIDOW(ER) with dependent child
enter child’s name here: ______________________________
Year spouse died: (See Instructions)_____________________
Check this box if you have filed an automatic
HAVE YOU FILED A FEDERAL EXTENSION?
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
00
X $23 =
M ultiply number of boxes checked from Line 7A
7B. First name(s) of dependent(s): (Do not list yourself or spouse)
Multiply number of dependents
00
X $23 =
____________________________________________
from Line 7B ..................................................
7C. First name of developmentally disabled individual(s): (See Instr.)
Multiply number of developmentally disabled
00
X $500 =
____________________________________________
individuals from Line 7C ................................
7D. TOTAL PERSONAL CREDITS: (Add Lines 7A, 7B and 7C. Enter total here and on Line 36) ................................... 7D
00
(C)
Arkansas
(A)
Your/Joint
(B) Spouse’s Income
ROUND ALL AMOUNTS TO WHOLE DOLLARS
Income Only
Income
Status 4 Only
00
00
00
8. Wages, salaries, tips, etc:
(Attach W-2s)
..................................................................8
Less
00
00
00
9A. U. S. Military compensation:
9A
(Your/joint gross amt.)
$9,000
Less
00
00
00
9B. U. S. Military compensation:
9B
(Spouse’s gross amt.)
$9,000
00
00
00
10. Minister’s income: Gross $ _____________ Less rental value $ _____________ 10
00
00
00
11. Interest income:
(If over $1,500, attach page AR4)
................................................11
00
00
00
12. Dividend income:
..............................................12
(If over $1,500, attach page AR4)
00
00
00
13. Alimony and separate maintenance received: .......................................................13
00
00
00
14. Business or professional income:
(Attach Federal Schedule C or C-EZ)
...............14
00
00
00
15. Capital gains/losses from stocks, bonds, etc:
(See Instr. Attach Federal Schedule D)
...15
00
00
00
16. Other gains or (losses):
(Attach Federal Form 4797)
.............................................16
00
00
00
17.
Non-Qualified IRA distributions and taxable annuities: (Attach 1099Rs)
...............17
00
18A. Your/Joint Employer pension plan(s)/Qualified IRA(s): (See Instructions - Attach 1099Rs)
Less
00
00
00
00
00
Gross Distribution
Taxable Amount
18A
$6,000
18B. Spouse Employer pension plan(s)/Qualified IRA(s):
(Filing Status 4 only)
Less
00
00
00
00
00
18B
Gross Distribution
Taxable Amount
$6,000
00
00
00
19. Rents, royalties, partnerships, estates, trusts, etc.:
(Attach Federal Schedule E)
.... 19
00
00
00
20. Farm income:
(Attach Federal Schedule F)
........................................................... 20
00
00
00
21. Other income/depreciation differences: (List type and amount. See Instr.) ............ 21
00
00
00
22. TOTAL INCOME: (Add Lines 8 through 21) ....................................................... 22
00
00
00
23.
Border city exemption: (Attach Form AR - TX)
....................................................... 23
00
00
00
24.
Arkansas Tax Deferred Tuition Savings Program: (See Instructions)
.................... 24
00
00
00
25. Total Other Adjustments:
(Attach Form
AR1000ADJ)............................................. 25
00
00
00
26. TOTAL ADJUSTMENTS: (Add Lines 23, 24, and 25) ...................................... 26
00
00
00
27. ADJUSTED GROSS INCOME: (Subtract Line 26 from Line 22) ..................... 27
Page NR1 (R 8/6/09)

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