Form Ar1000s - Arkansas Individual Income Tax Return - Full Year Resident / Short Form - 1999

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DEPT USE ONLY
S
1999 AR1000S
ARKANSAS INDIVIDUAL INCOME TAX RETURN
Full Year Resident / Short Form
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:
4.
MARRIED FILING SEPARATELY ON THE SAME RETURN:
1.
SINGLE: (Or widowed before 1999 or divorced at end of 1999)
5.
IF FILING STATUS 5, USE AR1000/AR1000NR - LONG FORM
2.
MARRIED FILING JOINT: (Even if only one had income)
6.
QUALIFYING WIDOW(ER): with dependent child.
3.
HEAD OF HOUSEHOLD: (See Instructions)
Year spouse died:(See Instructions) ____________________
If the qualifying person is your child but not your dependent,
enter this child’s name here: __________________________
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 $20 =
7B. First name(s) of dependents: (Do not list yourself or spouse)
Multiply number of boxes checked from Line 7A ..........
X $20 =
00
____________________________________________
Multiply number of dependents from Line 7B ................
7C.TOTAL PERSONAL CREDITS: (Add Lines 7A and 7B. Enter total here and on Line 16). ............................................... 7C
00
Spouse Income
ROUND ALL INCOME FIGURES TO WHOLE DOLLARS
A
Your Income
B
Status 4 Only
8. Wages, salaries, tips, etc.: ....................................................................................................... 8
00
8
00
00
00
9. Interest income/dividend income:
9
9
(If either interest or dividend are over $400.00, attach page ARS2). ..
00
00
10. Miscellaneous income: (List type and amount. See Instructions). .......................................... 10
10
00
00
11. TOTAL INCOME: (Add Lines 8 through 10). .......................................................................... 11
11
12. Select Tax Table:
LOW INCOME Table 1
REGULAR Table 2
Standard Deduction: (See Instructions).
00
00
NOTE: If you qualify for the Low Income Table, enter zero (0) on Line 12A. ......................... 12
12
00
00
13. Taxable Income. (Subtract Line 12 from Line 11). ................................................................. 13
13
00
00
14. Enter tax from table: .............................................................................................................. 14
14
00
15. TOTAL TAX: (Add Lines 14A and 14B). ........................................................................................................................... 15
00
16. Personal Tax credits. (Enter total from Line 7C). ................................................................... 16
00
17. Working Taxpayer credit: (See Instructions. Attach AR1328). ............................................... 17
00
18. Child Care credit: (Attach Federal schedule, 20% of Federal credit allowed). ........................ 18
00
19. TOTAL CREDITS: (Add Lines 16 through 18). .................................................................................................................. 19
00
20. NET TAX: (Subtract Line 19 from Line 15. If Line 19 is greater than Line 15, enter 0). ..................................................... 20
00
21. Arkansas Income Tax withheld: (Attach State copies of W-2s). ............................................. 21
22. Early Childhood Program: Certification Number: __________________________________
(Attach Fed. Form 2441 or 1040A & Cert. Form AR1000EC. 20% of Fed. credit allowed). .... 22
00
23. TOTAL PAYMENTS: (Add Lines 21 and 22). .................................................................................................................... 23
00
24. AMOUNT OF OVERPAYMENT/REFUND: (If Line 23 is greater than Line 20, enter difference). ...................................... 24
00
25. Amount to be contributed to AR Disaster Relief Fund: ........................................................... 25
00
26. Amount to be contributed to the U. S. Olympic Fund: ............................................................ 26
00
J
27. AMOUNT TO BE REFUNDED TO YOU: (Subtract Lines 25 and 26 from Line 24). .......................................... REFUND 27
00
L
28. Amount Due: (If Line 23 is less than Line 20, enter the difference; If over $1,000.00, See Instructions). ......... TAX DUE 28
00
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.
Date:
Your Signature
Occupation:
Spouse’s Signature
Occupation:
Date:
Paid Preparer’s Signature:
ID Number/Social Security Number:
FOR DEPARTMENT USE ONLY
A
B
Preparer’s Name:
City/State/Zip:
C
Address:
Telephone Number:
D
Mail REFUND returns to:
DFA State Income Tax, P. O. Box 1000, Little Rock, AR 72203-1000.
Mailing Information
E
Mail TAX DUE returns to:
DFA State Income Tax, P. O. Box 2144, Little Rock, AR 72203-2144.
Mail NO TAX DUE returns to:
DFA State Income Tax, P. O. Box 8026, Little Rock, AR 72203-8026.
F
Page AR1000S (R 11/99)
55

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