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2002 AR1000S

ARKANSAS INDIVIDUAL INCOME TAX RETURN

Full Year Resident / Short Form

DEPT USE ONLY

Jan 1 - Dec 31, 2002 or Fiscal Year Ending

, 20

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

LAST NAME(S) (See Instructions)

YOUR SOCIAL SECURITY NUMBER

PRESENT ADDRESS - NUMBER AND STREET, APARTMENT OR RURAL ROUTE

SPOUSE SOCIAL SECURITY NUMBER

CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE

HOME TELEPHONE:

WORK TELEPHONE:

SINGLE: (Or widowed before 2002 or divorced at end of 2002)

MARRIED FILING SEPARATELY ON THE SAME RETURN:

IF FILING STATUS 5, USE AR1000/AR1000NR - LONG FORM

MARRIED FILING JOINT: (Even if only one had income)

HEAD OF HOUSEHOLD: (See Instructions)

QUALIFYING WIDOW(ER): with dependent child.

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

Year spouse died:(See Instructions) _____________________

enter this child’s name here: __________________________

Check this box if you have filed an Automatic

HAVE YOU FILED A FEDERAL EXTENSION?

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: (Do not list yourself or spouse)

Multiply number of boxes checked from Line 7A

________________________________________________

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

X $20 =

7C.TOTAL PERSONAL CREDITS: (Add Lines 7A and 7B. Enter total here and on Line 16) .................................................. 7C

Your/Total

B Spouse Income

ROUND ALL INCOME FIGURES TO WHOLE DOLLARS

Income

Status 4 Only

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

Interest income/dividend income:

(If either interest or dividend are over $1,500, attach page ARS2) ........

10.

Miscellaneous income:

(List type and amount. See

Instructions). ............................................. 10

11.

TOTAL INCOME: (Add Lines 8 through 10) ............................................................................. 11

LOW INCOME Table 1

REGULAR Table 2

12.

Select Tax Table:

Standard Deduction: (See Instructions)

NOTE: If you qualify for the Low Income Table, enter zero (0) on Line 12A. .............................. 12

13.

Taxable Income. (Subtract Line 12 from Line 11) ..................................................................... 13

14.

Enter tax from table: .............................................................................................................. 14

15.

TOTAL TAX: (Add Lines 14A and 14B). ................................................................................................................................. 15

16.

Personal Tax credits. (Enter total from Line 7C) ....................................................................... 16

17.

Working Taxpayer credit: (See Instructions. Attach AR1328) .................................................... 17

18.

Child Care credit:

(Attach Federal schedule, 20% of Federal credit

allowed). ............................ 18

19.

TOTAL CREDITS: (Add Lines 16 through 18) ........................................................................................................................ 19

20.

NET TAX: (Subtract Line 19 from Line 15. If Line 19 is greater than Line 15, enter 0) ............................................................... 20

21.

Arkansas Income Tax withheld:

(Attach State copies of

W-2s). ................................................ 21

22.

Early Childhood Program: Certification Number: ______________________________

(Attach Fed. Form 2441 or 1040A, Sch. 2 & Cert. Form AR1000EC, 20% of Fed. credit

allowed). ......

23.

TOTAL PAYMENTS: (Add Lines 21 and 22) .......................................................................................................................... 23

24.

AMOUNT OF OVERPAYMENT/REFUND: (If Line 23 is greater than Line 20, enter difference) ............................................... 24

25.

Amount to be contributed to AR Disaster Relief Fund: ............................................................. 25

26.

Amount to be contributed to the U. S. Olympic Fund: .............................................................. 26

27.

Amount to be contributed to the AR Schools for the Blind and Deaf: ........................................ 27

☺

28.

AMOUNT TO BE REFUNDED TO YOU: (Subtract Lines 25, 26 and 27 from Line 24) ............................................ REFUND 28

29.

Amount Due: (If Line 23 is less than Line 20, enter the difference; If over $1,000 See Instructions) .......................... TAX DUE 29

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 knowledge

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.

Your Signature

Occupation

Date

May the Arkansas Revenue

Agency discuss this return with

the preparer shown below?

Spouse’s Signature

Date

Occupation

Yes

FOR DEPARTMENT USE ONLY

Paid Preparer’s Signature