Annual Corporation Franchise Tax Report Form - Ar Secretary Of State - 2017
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1Mark Martin
, Arkansas Secretary of State
000000000
ANNUAL CORPORATION FRANCHISE TAX REPORT 2017
For the year ending 12/31/2016
Reports and taxes are due on or before May , 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
1.
Anytime Day Or Night At
.
Current Names of Corporate Governors:
President:
2.
Vice President:
Correct any of the below information, if needed:
Secretary:
Tax Contact Name:
Treasurer:
Address:
Controller:
Address 2:
Tax Preparer:
City, State, Zip:
Phone # of Tax Contact:
7
Date of Qualification:
E-mail Address:
State of Incorporation:
Required Information:
Nature of Business:
Federal Tax ID#:
.
TOTAL AUTHORIZED CAPITAL STOCK
(See Instruction 8)
3.
___ A
4, 5, 6, 7 8
LL OF THE INFORMATION IN SECTIONS
NUMBER OF SHARES
PAR VALUE EACH
HAS BEEN VERIFIED AND HAS BEEN FOUND TO
.
’
BE EXACTLY THE SAME AS LAST YEAR
S REPORT
a)
$
b)
$
4.
Registered Agent Information:
c)
$
Name:
NO PAR VALUE = $25 PER SHARE
Address:
.
ISSUED AND OUTSTANDING CAPITAL STOCK
Address 2:
(See Instruction 9)
City, State, Zip:
NUMBER OF
SHARES
PAR VALUE EACH
TOTAL
Principal Office Information (in Arkansas):
a)
X $
= $
Address:
b)
X $
= $
City, State, Zip:
c)
X $
= $
d)
(Add 7a + 7b + 7c) TOTAL:
= $
NO PAR VALUE = $25 PER SHARE
.
TAX DUE
MINIMUM TAX DUE $150 • IF LESS THAN $150 PAY $150 • CORPORATIONS 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 _________________________, _____________
(Year)
(Month)
(Day)
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 , 2017 – Penalty and interest due after May , 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. 1 /1
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