Form Ar1000s - Arkansas Individual Income Tax Return - 2011

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S1
2011 AR1000S
ARKANSAS INDIVIDUAL
INCOME TAX RETURN
CHECK BOX IF
Full Year Resident/Short Form
AMENDED RETURN
Dept. Use Only
Jan. 1 - Dec. 31, 2011 or fiscal year ending _________ , 20 ___
PRIMARY NAME
MI
LAST NAME
PRIMARY SOCIAL SECURITY NUMBER
SPOUSE NAME
MI
LAST NAME
SPOUSE’S SOCIAL SECURITY NUMBER
MAILING ADDRESS
(Number and Street, P.O. Box or Rural Route)
IMPORTANT
Enter SSN(s) above
CITY, STATE AND ZIP CODE
Check this box if you have filed a state
extension or an automatic federal extension
HAVE YOU FILED AN EXTENSION?
1.
SINGLE (Or widowed before 2011 or divorced at end of 2011)
4.
MARRIED FILING SEPARATELY ON THE SAME RETURN
2.
MARRIED FILING JOINT (Even if only one had income)
IF FILING STATUS 5, USE AR1000F/AR1000NR - LONG FORM
5.
3.
HEAD OF HOUSEHOLD (See Instructions)
If the qualifying person is your child but not your dependent,
6.
QUALIFYING WIDOW(ER) with dependent child
enter child’s name here: ______________________________
Year spouse died: (See Instructions)_____________________
7A.
YOURSELF
65 or OVER
65 SPECIAL
BLIND
DEAF
HEAD OF HOUSEHOLD/ QUALIFYING WIDOW(ER)
(Filing Status 3 Only)
(Filing Status 6 Only)
SPOUSE
65 or OVER
65 SPECIAL
BLIND
DEAF
00
Multiply number of boxes checked from Line 7A
X $23=
7B. Dependents
(Do not list yourself or spouse)
Dependent’s Social Security Number Dependent’s relationship to you
First Name
Last Name
1.
2.
3.
Multiply number of dependents from Line 7B.....
X $23 =
00
7C. TOTAL PERSONAL CREDITS: (Add Lines 7A and 7B. Enter total here and on Line 16) ................................................7C
00
(A)
Your/Joint
(B)
Spouse’s Income
ROUND ALL AMOUNTS TO WHOLE DOLLARS
Income
Status 4 Only
00
00
8.
Wages, salaries, tips, etc:
(Attach
W-2s)............................................................................
8
8
9.
9
00
9
00
Interest income/dividend income:
(If interest or dividends are over $1,500, attach page
ARS2)....
10.
Miscellaneous income:
(List type and amount. See
instructions).......................................
10
00
10
00
TOTAL INCOME: (Add Lines 8 through 10)....................................................................
11.
11
00
11
00
NOTE:
LOW INCOME Table
REGULAR Table
If you qualify for the Low Income Table, enter zero (0) on Line 12
12.
Select tax table:
Standard Deduction: (See Instructions)..............................................................................
12
00
12
00
00
13.
Taxable Income: (Subtract Line 12 from Line 11)...............................................................
13
00
13
00
14.
Enter tax from table:............................................................................................................
14
00
14
TOTAL TAX: (Add Lines 14A and 14B)..........................................................................................................................
00
15.
15
00
16.
Personal Tax Credits: (Enter total from Line 7C).................................................................
16
00
17.
Child Care Credit:
(20% of federal credit allowed, attach federal Form
2441).................................
17
TOTAL CREDITS: (Add Lines 16 and 17).....................................................................................................................
18.
18
00
NET TAX: (Subtract Line 18 from Line 15. If Line 18 is greater than Line 15, enter 0)..................................................
19.
19
00
20.
Arkansas Income Tax withheld:
[Attach state copies of W-2
Form(s)]................................
20
00
21.
AMENDED RETURNS ONLY
- Previous payments (see instructions):..............................
21
00
22.
Early Childhood Prog: Cert. # (Attach form. See inst.) ___________________________
22
00
TOTAL PAYMENTS: (Add Lines 20 through 22).............................................................
23.
23
00
24.
AMENDED RETURNS ONLY
- Previous refund (see instructions)...................................................................................
24
00
25.
Adjusted Total Payments
(Subtract Line 24 from Line 23)................................................................................................
25
00
AMOUNT OF OVERPAYMENT/REFUND: (If Line 25 is greater than Line 19, enter difference)..............................
26.
26
00
27.
Amount of Check-off Contributions:
(Attach Schedule
AR1000-CO)..................................
27
00
AMOUNT TO BE REFUNDED TO YOU: (Subtract Line 27 from Line 26) ...............................................REFUND
28.
28
00
AMOUNT DUE: (If Line 25 is less than Line 19, enter difference; If over $1,000 see inst.) ........................TAX DUE
29.
29
00
Attach Form AR1000V to your check or money order payable in US Dollars to Dept. of Finance & Admin. Write SSN on payment. For Credit card, see inst.
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 knowl-
edge 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
Phone Number:
Your Signature
Spouse’s Signature
Occupation
Date
May the Arkansas Revenue
Agency discuss this return
with the preparer of the return?
ID Number/Social Security Number
Paid Preparer’s Signature
Yes
No
Preparer’s Name:
City/State/Zip:
For Department Use Only
A
Telephone Number:
Address:
Page ARS1 (R 8/5/2011)

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