Form Ar1000s - Arkansas Individual Income Tax Return Full Year Resident/short Form - 2003

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2003 AR1000S

ARKANSAS INDIVIDUAL INCOME TAX RETURN

Full Year Resident/Short Form

Dept. Use Only

Jan 1 - Dec 31, 2003 or fiscal year ending ________ , 20 __

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

LAST NAME(S) (See Instructions)

YOUR SOCIAL SECURITY NUMBER

PRESENT ADDRESS - NUMBER AND STREET, APARTMENT OR RURAL ROUTE

SPOUSE’S SOCIAL SECURITY NUMBER

CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE

HOME TELEPHONE:

WORK TELEPHONE:

SINGLE (Or widowed before 2003 or divorced at end of 2003)

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 child’s name here: ______________________________

Check box if you have filed an Auto-

HAVE YOU FILED A FEDERAL EXTENSION?

matic Federal Extension Form 4868.

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 18) ................................................... 7C

(A)

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 12. ............................... 12

13.

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

14.

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

15.

Combined tax: (Add Lines 14A and 14B) ............................................................................................................................. 15

16.

Income Tax Surcharge: (Multiply Line 15 by .03) .................................................................................................................. 16

17.

TOTAL TAX: Add Lines 15 and 16). .................................................................................................................................... 17

18.

Personal Tax Credits. (Enter total from Line 7C) ..................................................................... 18

19.

Child Care Credit:

(Attach Federal schedule, 20% of Federal credit

allowed.). ......................... 19

20.

TOTAL CREDITS: (Add Lines 18 and 19) ........................................................................................................................... 20

21.

NET TAX: (Subtract Line 20 from Line 17. If Line 20 is greater than Line 17, enter 0) ............................................................. 21

22.

Arkansas Income Tax withheld:

[Attach State copies of W-2

Form(s)]. ..................................... 22

23.

Early Childhood Program: Certification Number: _______________________________

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

allowed). ....

24.

TOTAL PAYMENTS: (Add Lines 22 and 23) ........................................................................................................................ 24

25.

AMOUNT OF OVERPAYMENT/REFUND: (If Line 24 is greater than Line 21, enter difference) .............................................. 25

26.

Amount of Check-off Contributions:

(Attach Schedule

AR1000-CO). ....................................... 26

☺

27.

AMOUNT TO BE REFUNDED TO YOU: (Subtract Line 26 from Line 25) .............................................................. REFUND 27

28.

Amount Due: (If Line 24 is less than Line 21, enter the difference; If over $1,000 see instructions) ........................... TAX DUE 28

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.

Date

May the Arkansas Revenue

Your Signature

Occupation

Agency discuss this return with

the preparer of the return?

Spouse’s Signature

Occupation

Date

Yes

For Department Use Only

Paid Preparer’s Signature