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AR1000A

2009

ARKANSAS INDIVIDUAL INCOME TAX

AMENDED RETURN

FULL YEAR RESIDENT

Jan. 1 - Dec. 31, 2009 or fiscal year ending _____________ 20 ____

Your Social Security Number

File Date

Amount Paid

FOR OFFICE

USE ONLY

First Name(s) and Initial(s) (List both if applicable)

Last Name

Spouse’s Social Security Number

Present Address (Number and Street, Apartment Number or Rural Route)

Preparer’s Identification Number

City, State, and Zip Code

Telephone Numbers

Home:

Work:

CHECK ONLY ONE BOX:

SINGLE (Or widowed before 2009 or divorced at end of 2009)

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)_____________________

7A.

YOURSELF

65 or OVER

65 SPECIAL

BLIND

DEAF

HEAD OF HOUSEHOLD/

QUALIFYING WIDOW(ER)

SPOUSE

65 or OVER

65 SPECIAL

BLIND

DEAF

7B. First name(s) of dependents: (Do not list yourself or spouse)

....

X $23 =

Multiply number of boxes checked from Line 7A

____________________________________________

.........

X $23 =

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 18) ................................................. 7D

PART 1:

ORIGINAL

PART 2:

AMENDED

A. Your/Joint

B. Spouse’s

A. Your/Joint

B. Spouse’s

INCOME

Income

8. Total Income: ........................................................8

9. Adjustments to Income: ........................................9

10. Adjusted Gross Income: .....................................10

11. Itemized/Standard Deductions: .......................... 11

12. Net Taxable Income: ...........................................12

TAX COMPUTATION

13. Select tax table: (Enter tax from applicable tax table). .........................................................................13

LOW INCOME

REGULAR

14. Combined Tax: (Enter total from Lines 13A and 13B) ...............................................................................................................14

15. Enter tax from ten (10) year averaging schedule: (Attach AR1000TD) .....................................................................................15

16. IRA and qualified plan withdrawal and overpayment penalties: (Attach federal Form 5329 if required) ................................... 16

17. Total Tax: (Add Lines 14 through 16. Enter here) ......................................................................................................................17

TAX CREDITS

18. Personal Tax Credit(s): (Enter total from Line 7D) ...............................................................................18

19. State Political Contributions Credit: (Attach AR1800) ..........................................................................19

20. Other State Tax Credit(s): [Attach copy of other State return(s)] ..........................................................20

21. Child Care Credit(s): (20% of federal credit allowed, Attach federal Form 2441) .................................21

22. Credit for Adoption Expenses: (Attach federal Form 8839) ..................................................................22

23. Phenylketonuria Disorder Credit: (Attach AR1113) ..............................................................................23

24. Business and Incentive Tax Credits: [Attach Schedule and Certificate(s)] ...........................................24

25. TOTAL CREDITS: (Add Lines 18 through 24) ...........................................................................................................................25

26. NET TAX: (Subtract Line 25 from Line 17. Enter here) .............................................................................................................26

AR1000A (R 10/5/09)

Form Ar1000a - Arkansas Individual Income Tax Amended Return Full Year Resident - 2009

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