Form Ar1000nr Draft - Arkansas Individual Income Tax Return Nonresident And Part Year Resident - 2009 Page 2
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1
2(A)
Your/Joint
(B) Spouse’s Income
Income
Status 4 Only
00
00
ADJUSTED GROSS INCOME: (From Line 27, Columns A and B, Page NR1) ...........28
28.
28
29. Select tax table: (Check the appropriate box)
LOW INCOME Table
REGULAR Table
If you qualify for the Low Income Tax Table, enter zero (0) on Line 29A. If not, then:
}
Itemized Deductions (See Instructions, Line 29)
Enter
the larger
OR
Standard Deduction (See Instructions, Line 29) .........................29
00
00
of your:
29
NET TAXABLE INCOME: (Subtract Line 29 from Line 28) ..........................................30
00
00
30.
30
TAX: (Enter tax from tax table) ..........................................................................................31
00
00
31.
31
00
32. Combined tax: (Add amounts from Lines 31A and 31B) .................................................................................................32
00
33.
Enter tax from Lump Sum Distribution Averaging Schedule: (Attach AR1000TD)
.......................................................... 33
00
34. IRA and qualified plan withdrawal and overpayment penalties:
(Attach Federal Form 5329, if required)
....................... 34
00
TOTAL TAX: (Add Lines 32 through 34) ......................................................................................................................35
35.
00
36. Personal Tax Credit(s): (Enter total from Line 7D, page NR1) ...........................................36
00
37. State Political Contributions Credit:
(Attach AR1800 or schedule)
.....................................37
00
38.
Other State Tax Credit: [Attach copy of other state tax return(s)]
.......................................38
00
39.
Child Care Credit:
(20% of Federal credit allowed; Attach Fed. Form 2441)
..............................39
00
40.
Credit for Adoption Expenses: (Attach Form 8839)
............................................................40
00
41.
Phenylketonuria Disorder Credit: (See Instructions. Attach AR1113)
.................................41
00
42.
Business and Incentive Tax Credit(s): [Attach schedule and certificate(s)]
........................42
00
TOTAL CREDITS: (Add Lines 36 through 42) .............................................................................................................43
43.
NET TAX: (Subtract Line 43 from Line 35. If Line 43 is greater than Line 35, enter 0) ................................................ 44
00
44.
44A. Enter the amount from Line 27, Column C: ............................................................... 44A
00
44B. Enter the total amount from Line 27, Columns A and B: ......................................... 44B
00
%
44C. Divide Line 44A by 44B: (See Instructions) ...................................................................................................................44C
44D. APPORTIONED TAX LIABILITY: (Multiply Line 44 by Line 44C) .........................................................................44D
00
00
45
Arkansas income tax withheld: [Attach State copies of W-2 Form(s)]
................................45
00
46. Estimated tax paid or credit brought forward from 2008: ...................................................46
00
47. Payment made with extension: (See Instructions) .............................................................47
48. Early childhood program: Certification Number: _________________________________
(20% of Fed. credit; Attach Fed. Form 2441 and Form AR1000EC)
00
.......................................48
TOTAL PAYMENTS: (Add Lines 45 through 48) .........................................................................................................49
00
49.
AMOUNT OF OVERPAYMENT/REFUND: (If Line 49 is greater than Line 44D, enter difference) ......................... 50
00
50.
00
51. Amount to be applied to 2010 estimated tax: .....................................................................51
00
52.
Amount of Check-off Contributions:
(Attach Schedule AR1000-CO)
.................................52
00
AMOUNT TO BE REFUNDED TO YOU: (Subtract Lines 51 and 52 from Line 50) ............................. REFUND 53
53.
00
AMOUNT DUE: (If Line 49 is less than Line 44D, enter difference; If over $1,000, see instructions) ..... TAX DUE 54
54.
00
55A.
Attach Form AR2210 or AR2210A. If required, enter exception in box
55A
Penalty 55B
55C. Attach your check or money order payable to “Dept. of Finance and Administration” for the tax due
00
and penalty (if any). Include your SSN on your check. To pay by credit card, see Page 17 ..............TOTAL DUE 55C
56. Income not subject to Arkansas tax from AR4, Part III:
May the Arkansas Revenue Agency discuss
Yes
No
this return with the preparer shown below?
PLEASE SIGN HERE:
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements,
and to the best of my knowledge and belief, they are true, correct and complete. Declaration of preparer (other than taxpayer) is based
on all information of which preparer has any knowledge.
SIGN HERE
Occupation
Date
Home Telephone:
Your Signature
Spouse’s Signature
Occupation
Date
Work Telephone:
Paid Preparer’s Signature
ID Number/Social Security Number
For Department Use Only
A
Preparer’s Name
City/State/Zip
B
C
Address
Telephone Number
D
Mail REFUND returns to:
DFA State Income Tax, P. O. Box 1000, Little Rock, AR 72203-1000
E
Mailing Information
Mail TAX DUE returns to:
DFA State Income Tax, P. O. Box 2144, Little Rock, AR 72203-2144
F
Mail NO TAX DUE returns to: DFA State Income Tax, P. O. Box 8026, Little Rock, AR 72203-8026
Please Note: DUE DATE IS APRIL 15, 2010
Page NR2 (R 8/12/09)
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