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2001 AR1000

ARKANSAS INDIVIDUAL INCOME TAX RETURN

Full Year Resident

Dept. Use Only

Jan 1 - Dec 31, 2001 or fiscal year ending

, 20

FIRST NAME(S) AND INITIAL(S) (List both if applicable)

LAST NAME(S) (See Instructions)

YOUR SOCIAL SECURITY NUMBER

SPOUSE SOCIAL SECURITY NUMBER

PRESENT ADDRESS - NUMBER AND STREET, APARTMENT OR RURAL ROUTE

HOME TELEPHONE:

CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE

WORK TELEPHONE:

SINGLE (Or widowed before 2001 or divorced at end of 2001)

MARRIED FILING SEPARATELY ON THE SAME RETURN

MARRIED FILING JOINT (Even if only one had income)

MARRIED FILING SEPARATELY ON DIFFERENT RETURNS

HEAD OF HOUSEHOLD (See Instructions)

Enter spouse’s name here and SSN above _________________

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

QUALIFYING WIDOW(ER) with dependent child.

enter this child’s name here: ____________________________

Year spouse died:(See Instructions) _______________________

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:

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

(Do not list yourself or spouse)

X $20 =

____________________________________________

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

7C. First name of developmentally disabled individual(s):

(See Instr.)

Multiply number of developmentally disabled

____________________________________________

X $500 =

individuals from Line 7C .......................................

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

Your/Total

Spouse Income

ROUND ALL INCOME FIGURES TO WHOLE DOLLARS

Income

Status 4 Only

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

(Your/joint gross amount ) ..........

9A. U. S. military compensation pay:

Less $6,000

(Spouse gross amount ) ............

9B. U. S. military compensation pay:

Less $6,000

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

11. Interest income: (If over $400, attach page AR4) .......................................................................... 11

12. Dividend income: (If over $400, 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

(Your/Joint gross amount )

18A. Employer pension plan/Qualified IRA:

18A

Less $6,000

(Spouse gross amount )

18B. Employer pension plan/Qualified IRA:

18B

Less $6,000

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

19. Rents, royalties, partnerships, estates, trusts, 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) ............................................................. 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) ........................................................ 27

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

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 individual:

(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 AR1 (R 10/01)

Form Ar1000 - Arkansas Individual Income Tax Return Full Year Resident - Ar Department Of Finance And Administration - 2001

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