Form Ar941m - State Of Arkansas Monthly Withholding Report - 1999

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STATE OF ARKANSAS
FOR DEPARTMENT USE ONLY
AR941M Monthly Withholding Report
Make your check payable to:
Department of Finance and Administration
DUE DATE
PERIOD COVERED
ID NUMBER
ZIP KEY
If you are no longer withholding AR tax,
Reason Closed
Address Change
Indicate the date you stopped.
(See back for Instructions)
_____
1. Tax Withheld
2. Adjustments
Business Name: _______________________________
3. Tax Due
Address: ____________________________________
__________________________________________
4. Interest
__________________________________________
5. Penalty
__________________________________________
6. Amount Paid
DO NOT MARK IN BOXES A, B, C OR D. - FOR DEPARTMENT USE ONLY
A.
B.
C.
D.
I declare under penalty, that I have examined this return and to the best of my knowledge and belief, is a true, correct and complete return.
Signature__________________________________________________________Date ___________________Telephone ____________________
INSTRUCTIONS
PERIOD COVERED AND DUE DATE
Enter the reporting period and due date for this coupon.
TAX WITHHELD
You can only report one period per coupon. All new accounts are reported
Enter the total amount of Arkansas Income Tax withheld for this reporting
and paid on the 15th of the following month. There is no quarterly filing.
period.
ID NUMBER
ADJUSTMENTS
Enter your Federal Identification Number.
Enter any adjustments to be deducted from the amount you will pay for this
period. You must include a detailed explanation of any adjustment you list.
ZIP KEY
Enter your 5-digit Zip Code.
TAX DUE
Subtract the adjustment amount from tax withheld.
DATE CLOSED
Enter the day the business closed or stopped withholding Arkansas taxes.
INTEREST AND PENALTY
This will close your withholding account with the State of Arkansas until you
List any Interest or Penalty amounts included with this report if your report is
re-register your business for withholding purposes.
made past the due date.
REASON CLOSED
AMOUNT PAID
Enter the number of the appropriate reason.
Add the Tax Due, Interest and Penalty amounts.
1. Business discontinued.
2. Business transferred to successor.
MAKE YOUR CHECK OR MONEY ORDER PAYABLE TO:
3. Change in organization.
Department of Finance and Administration
4. Discharged all employees but continuing in business.
5. Other. (Specify): _______________________________
MAIL TO:
Other. (Specify):
_______________________________
P. O. Box 9941, Little Rock, Arkansas 72203-9941
AR941M (8/99)

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