Form Et-180a - Contractor Tax Rate Change Rebate

Download a blank fillable Form Et-180a - Contractor Tax Rate Change Rebate in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Et-180a - Contractor Tax Rate Change Rebate with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ARKANSAS DEPARTMENT OF FINANCE AND ADMINISTRATION

CONTRACTOR TAX RATE CHANGE REBATE FORM ET-180A

■ Attach Supporting Documents including a copy of the Contract

■ Read Instructions

Sales Tax Permit #

1) Company Name

2) FEIN

3) Mailing Address

4) City

5) State

6) Zip

If you do not have an Arkansas Sales Tax Permit Number, complete the following section.

7) Owner's Name

8) NAICS Code of Business

9) Type of Ownership

10) Location Address

11) City

12) State

13) Zip

14) Contact Name

15) Contact Phone Number

Please complete the section below with information from the sales invoices on which you are claiming the local tax rebate. Please Note: Information provided on this form will be subject to Audit. Information found to be fraudulent

will result in loss of your local tax rebate and assessment of penalties.

16) Contract ID

17) Contract Date

20) County Where Purchased or Delivered/Shipped

21) County Tax Code

18) Invoice Number

19) Invoice Date

22) City Where Purchased or Delivered/Shipped

23) City Tax Code

24) Invoice Total Amount

27) State Rebate Amount

25) Sales Tax Paid at 6.5%

26) Sales Tax at 6%

(Do Not Include Tax Paid)

(Block 25 - Block 26)

State

30) Invoice Amount Eligible for

34) Local Rate Change Rebate

28) Invoice Total Amount

32) Local Tax Rebate

35) Total Local Rebate

29) Standard Cap Amount

Rebate

31) Current Local Tax Rate

33) Previous Rate

Amount

(Do Not Include Tax Paid)

Amount

(Block 32 + Block 34)

(Block 28 - Block 29)

(Block 31 - Block 33) X $2,500

County Tax Code

-2,500.00

- $2,500.00 =

% =

City Tax Code

-2,500.00

- $2,500.00 =

% =

36) Rebate Claim Amount (From Invoice(s) Listed Above)

37) Rebate Claim Amount (ContractorTax Rate Change

Rebate Supplemental Sheet Total)

38) Total Rebate Claim Amount

(Combine Line 36 and 37)

Under penalties of law, I declare that the amount of sales or use tax for which I am submitting this claim for refund has NOT been refunded or credited to me by the Department or the seller to whom the tax was previously paid. I will

immediately send payment for any such duplicate refund to the Arkansas Department of Finance & Administration; PO Box 3566, Little Rock, AR 72203-3566.

39) Signature

40) Date

Mail To: SALES & USE TAX SECTION

Contact:

Phone: 501-682-7105

P O. BOX 3566

Fax: 501-682-7904

LITTLE ROCK, AR 72203-3566

Web site: