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Instructions for Nonresident Member

Withholding Exemption Affidavit

Requirement to Make Withholding Payments

Arkansas Code Annotated 26-51-919(b)(1)(A) requires a pass-through entity to withhold income tax at the rate of 7% on each

nonresident member’s share of distributed Arkansas income. A pass-through entity is not required to withhold income tax for

any nonresident member who submits a Nonresident Member Withholding Exemption Affidavit (Form AR4PT).

Instructions for Nonresident Member

Any nonresident member receiving a distribution of Arkansas income from a pass-through entity may claim an exemption from

the withholding requirement by completing Parts A, B, C and E and submitting the completed affidavit to the pass-through

entity.

A nonresident member who has previously received an exemption from the withholding requirement may revoke such exemption

by completing Parts A, B, D and E and submitting the completed affidavit to the pass-through entity.

If any of the information provided in Parts A or B changes, a new affidavit must be filed with the pass-through entity.

Instructions for Pass-through Entity

The pass-through entity must retain the original Nonresident Member Withholding Exemption Affidavits and provide copies to

the Arkansas Department of Finance and Administration (DFA) upon request. All pass-through entities must provide DFA on

an annual basis with the name, address, and identification number of all nonresident members for whom they have received

a Nonresident Member Withholding Exemption Affidavit on an annual basis as described below:

a. Pass-through entities are required to file the nonresident member affidavit information on a CD or diskette using a

spreadsheet format (such as Excel), a database format (such as Access), or a Delimited Text File. Due to security

reasons, the information cannot be sent electronically at this time. All of the information shown in Parts A and B

must be provided using the predefined record layouts. The predefined record layouts may be accessed on our

website at

b. Please file the CD or diskette using transmittal Form AR4PT-A by the due date of the pass-through entity’s income

tax return, including extensions, at the address below.

c. To obtain a waiver from filing on a CD or diskette, the pass-through entity must mail a request to the DFA at the

address below and detail any hardship that would result if required to file on a CD or diskette.

d. For those pass-through entities that are granted a waiver, copies of all Nonresident Member Withholding Exemption

Affidavits must be filed using transmittal Form AR4PT-A by the due date of the pass-through entity’s income tax

return, including extensions, at the address below.

Mailing Address

Individual Income Tax Section

Pass-Through Entity

Post Office Box 3628

Little Rock, AR 72203-3628

AR4PT Instr (R 10/29/09)

Form Ar4pt Draft - Nonresident Member Withholding Exemption Affidavit - Arkansas 2009 Page 2