$5
ITAR152
Primary SSN _______- _____- ________
(A)
Your/Joint
% 6SRXVH·V ,QFRPH
Income
6WDWXV 2QO\
$'-867(' *5266 ,1&20( (From Line 23, Columns A and B) ............................
00
00
24.
24
25.
Select tax table: (See Instructions, Line 25)
LOW INCOME Table
5(*8/$5 Table
If you qualify for the Low Income Tax Table, enter zero (0) on Line 25A. If not, then:
}
,WHPL]HG 'HGXFWLRQV (See Instructions, Line 25 and
attach AR3)
Enter
the ODUJHU
OR
If your spouse itemizes on a separate return, check here
of your:
6WDQGDUG 'HGXFWLRQ (See Instructions, Line 25) .......................
00
00
25
1(7 7$;$%/( ,1&20( (Subtract Line 25 from Line 24) ........................................
00
00
26.
26
TAX: (Enter tax from tax table) ........................................................................................
00
00
27.
27
00
28.
Combined tax: (Add amounts from Line 27, Columns A and B) .....................................................................................
28
00
29.
Enter tax from Lump Sum Distribution Averaging Schedule:
(Attach AR1000TD)
.........................................................
29
00
30.
$GGLWLRQDO WD[ RQ ,5$ DQG TXDOL¿HG SODQ ZLWKGUDZDO DQG RYHUSD\PHQW
(Attach federal Form 5329, if required)
...........
30
TOTAL TAX: (Add Lines 28 through 30) ......................................................................................................................
00
31.
31
00
Personal Tax Credit(s): (Enter total from Line 7D) ..............................................................
32.
32
00
Child Care Credit:
(20% of federal credit allowed; Attach federal Form 2441)
............................
33
33.
Other Credits:
(Attach AR1000TC)
...............................................................................................
34
00
34.
727$/ &5(',76 (Add Lines 32 through 34) ............................................................................................................
35.
35
00
NET TAX: (Subtract Line 35 from Line 31. If Line 35 is greater than Line 31, enter 0) ...............................................
36.
36
00
00
37.
Arkansas income tax withheld:
[Attach state copies of W-2 and/or 1099R Form(s)]
.........
37
00
38.
Estimated tax paid or credit brought forward from 2014:...................................................
38
00
39.
Payment made with extension: (See Instructions) ............................................................
39
00
40.
AMENDED RETURNS ONLY
- Previous payments: (See instructions) ...........................
40
(DUO\ FKLOGKRRG SURJUDP &HUWL¿FDWLRQ 1XPEHU BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
41.
(20% of federal credit; Attach federal Form 2441 DQG Form AR1000EC)
..............................
41
00
TOTAL PAYMENTS: (Add Lines 37 through 41)........................................................................................................
00
42.
42
00
43.
AMENDED RETURNS ONLY
- Previous refund: (See instructions) ..............................................................................
43
00
44.
Adjusted Total Payments
: (Subtract Line 43 from Line 42).............................................................................................
44
$02817 2) 29(53$<0(175()81' (If Line 44 is greater than Line 36, enter difference) ...........................
45.
45
00
00
Amount to be applied to 2016 estimated tax: ....................................................................
46.
46
00
47.
47
Amount of Check-off Contributions:
(Attach Schedule
AR1000-CO).................................
-
$02817 72 %( 5()81'(' 72 <28 (Subtract Lines 46 and 47 from Line 45) ..................................
5()81'
00
48.
48
',5(&7 '(326,7" If you want your refund direct deposited you must check this box
and
FRPSOHWH )RUP $5'' and attach it to your return. (Direct deposit is not available for amended returns.)
/
AMOUNT DUE: (If Line 44 is less than Line 36, enter difference; If over $1,000, continue to 50A) ..........
TAX DUE
00
49.
49
00
50A.
UEP: Attach Form AR2210 or AR2210A. If required, enter exception in box
50A
Penalty
50B
50C.
Add Lines 49 and 50B. Attach Form AR1000V with check or money order payable in U.S. Dollars to “Dept. of Finance
TOTAL DUE
50C
00
and Administration”. Include your SSN on payment. To pay by credit card, see instructions
.................
51.
Amount of income not subject to Arkansas tax from AR4, Part III: (Memorandum only)
May the Arkansas Revenue Agency discuss
this return with the preparer shown below?
Yes
No
)25 0$,/,1* $''5(66(6 6(( 3$*( 2) ,16758&7,216
3/($6( 6,*1 +(5(
8QGHU SHQDOWLHV RI SHUMXU\ , GHFODUH WKDW , KDYH H[DPLQHG WKLV UHWXUQ DQG DFFRPSDQ\LQJ VFKHGXOHV
DQG VWDWHPHQWV DQG WR WKH EHVW RI P\ NQRZOHGJH DQG EHOLHI WKH\ DUH WUXH FRUUHFW DQG FRPSOHWH 'HFODUDWLRQ RI SUHSDUHU RWKHU
WKDQ WD[SD\HU LV EDVHG RQ DOO LQIRUPDWLRQ RI ZKLFK SUHSDUHU KDV DQ\ NQRZOHGJH
Your Signature
Occupation
Date
Telephone:
6,*1 +(5(
Spouse’s Signature
Occupation
Date
Alternate Telephone:
Paid Preparer’s Signature
ID Number/Social Security Number
)RU 'HSDUWPHQW 8VH 2QO\
A
Preparer’s Name
City/State/Zip
Address
Telephone Number
Page AR2 (R 5/19/15)
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