Form Ar4p - Employee'S Withholding Certificate For Pensions And Annuity Payments
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2AR4P
STATE OF ARKANSAS
Employee’s Withholding Certificate
For Pensions and Annuity Payments
Social Security Number
Name
Home Address (number and street or rural route)
Claim or identification number (if any) of
your pension or annuity contract
City, State and ZIP
CHECK HERE if you do not want any Arkansas income tax withheld from your pension or annuity. (Do not complete lines 1 through 5)
1. CHECK ONE OF THE FOLLOWING and enter amount of allowances claimed.
No allowances or dependents claimed. (Enter zero on lines 1, 2, and 3)
Single and you claim yourself. (Enter one allowance)
Married and you claim yourself and your spouse. (Enter two allowances)
Head of Household, and you claim yourself. (Enter two allowances) ......................................................................1 ____________
2. NUMBER OF CHILDREN or DEPENDENTS. (Enter one allowance per dependent) .........................................................................2 ____________
0
3. TOTAL ALLOWANCES. (Add Lines 1 and 2. If no allowances or dependents are claimed, enter zero) .............................................3 ____________
4. Additional amount, if any, you want deducted from each pension or annuity payment. (Enter dollar amount) ...................................4
5. I qualify for the low income tax rates. (See below for details) .............................................................................................................5
Please check filing status:
Single
Married Filing Jointly
Head of Household
I certify that the number of allowances and dependents claimed on this certificate does not exceed the number to which I am entitled.
Signature: ________________________________________________________________________________________Date: _________________
Instructions for Completing the
Withholding Certificate for Pension and Annuity Payments
Generally, Arkansas income tax withholding applies to the taxable
3. CHANGES IN ALLOWANCES – You may file a new certificate at
portion of payments made from pension, profit-sharing, stock bonus, an-
any time if the number of allowances INCREASES. You must file a new
nuity, and certain deferred compensation plans; from individual retirement
certificate within 10 days if the number of allowances previously claimed
arrangements (IRAs); and from commercial annuities. The first $6,000 per
by you DECREASES for any of the following reasons:
year of a pension distribution or qualified traditional IRA distribution may
(a) Your spouse for whom you have been claiming an allowance is
be tax exempt. Also, qualified distributions from a Roth IRA are nontaxable
divorced or legally separated, or claims his or her own allowance
and, therefore, not subject to withholding.
on a separate certificate, or
(b) The support of a dependent for whom you claimed an allowance
1. NUMBER OF ALLOWANCES – Do not claim more than the correct
is expected to be less than half of the total support for the year.
number of allowances. However, if you expect to owe more income tax for
OTHER DECREASES in allowances, such as the death of a
the year, you may increase your withholding by claiming a smaller number
spouse or a dependent, do not affect your withholding until next
of allowances, or you may enter into an agreement with your payer to have
year, but require the filing of a new certificate by December 1,
additional amounts withheld. This is especially important if you have more
of the year in which they occur.
than one payer, or if both husband and wife are receiving payments.
4. Claim additional amounts of withholding tax if desired. This will apply
2. DEPENDENTS – To qualify as your dependent, a person must (a)
most often when you have income other than wages.
receive more than 1/2 of their support from you for the year, (b) not be
5. You qualify for the low income tax rates if your total income from all
claimed as a dependent by such person’s spouse, (c) be a citizen or
resident of the United States, and (d) have your home as their principle
sources are as shown below:
residence and be a member of your household for the entire year or be
related to you as follows: son, daughter, grandchild, stepson, stepdaughter,
(a) Single
$10,941 to $14,400
son-in-law or daughter-in-law; Your father, mother, grandparent, stepfather,
(b) Married Filing Jointly
$18,449 to $22,900
stepmother, father-in-law or mother-in-law; Your brother, sister, stepbrother,
(1 or less dependents)
stepsister, half brother, half sister, brother-in-law or sister-in-law; Your
(c) Married Filing Jointly
$22,203 to $28,700
uncle, aunt, nephew or niece (but only if related by blood), or, an individual
(2 or more dependents)
(other than your spouse) who, for the taxable year of the taxpayer, had the
(d)
Head of Household/Qualifying Widow(er) $15,553 to $20,200
same principal place of abode as the taxpayer and was a member of the
(1 or less dependents)
taxpayer’s household.
(e)
Head of Household/Qualifying Widow(er) $18,540 to $22,900
(2 or more dependents)
Once the filing status and number of allowances are established, use the
For additional information consult your Plan Administrator or:
Arkansas Withholding Tables to determine the amount of tax to withhold
from each distribution.
Arkansas Withholding Tax Section
P. O. Box 8055
Little Rock, Arkansas 72203-8055
AR4P (R 01/03/12)
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