Annual Bank Franchise Tax Report - 2017

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000000000
Mark Martin
, Arkansas Secretary of State
ANNUAL BANK FRANCHISE TAX REPORT 2017
For the year ending 12/31/2016
Reports and taxes are due on or before May 1, 2017. Penalty and interest will be due for reports if the United States Postal Service’s
postmark is after the deadline. Complete this report online at , or sign in black ink and mail to the address
listed below.
Save Time & File Online
Business Name and Address:
1.
Anytime Day Or Night At
(Name)
(Address)
5.
TOTAL AUTHORIZED CAPITAL STOCK
(See Instruction 5)
(City, State, Zip Code)
NUMBER OF SHARES
PAR VALUE EACH
2.
Correct any of the below information, if needed:
a)
$
Tax Contact Name:
b)
$
Address:
c)
$
Address 2:
NO PAR VALUE = $25 PER SHARE
City, State, Zip:
Phone # of Tax Contact:
6.
ISSUED AND OUTSTANDING CAPITAL STOCK
E-mail Address:
(See Instruction 6)
NUMBER OF
Required Information:
SHARES
PAR VALUE EACH
TOTAL
Federal Tax ID#:
a)
X $
= $
b)
X $
= $
3.
___ A
4, 5,
6
LL OF THE INFORMATION IN SECTIONS
&
c)
X $
= $
HAS BEEN VERIFIED AND HAS BEEN FOUND TO BE
.
d)
(Add 6a + 6b + 6c) TOTAL:
= $
EXACTLY THE SAME AS LAST YEAR
S REPORT
NO PAR VALUE = $25 PER SHARE
4.
State of:
County of:
Date of Qualification:
=
÷
=
=
7.
X
Total Real &
Arkansas Real &
Percentage (%)
Amount from Line 6d
Arkansas Capital Stock X .003
TAX DUE
Personal Property
Personal Property
MINIMUM TAX DUE $150 • IF LESS THAN $150 PAY $150 • BANKS WITHOUT AUTHORIZED STOCK PAY $300
I declare, under the penalties of perjury, that the foregoing statements are true to the best of my knowledge and belief.
Executed this ______________ day of _________________________, _____________
(Day)
(Month)
(Year)
Print Name____________________________________________ Signature____________________________________________
Must be printed in black ink by: Pres., Vice Pres., Sec., Treas., Cont., or Tax Preparer
Must be signed in black ink by: Pres., Vice Pres., Sec., Treas., Cont., or Tax Preparer
Due on or before May 1, 2017 – Penalty and interest due after May 1, 2017
You may file this online at
Remittance must accompany this report • Make checks payable to Arkansas Secretary of State
Phone: 501-682-3409 or Toll Free: 888-233-0325
Mail to: Business and Commercial Services Division • P.O. Box 8014 • Little Rock, Arkansas 72203-8014
Rev. 11/16

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