Form Ar4 - Interest And Divident Income Schedule - Arkansas Individual/fiduciary Income Tax - 2015

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AR4
2015
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ARKANSAS INDIVIDUAL/FIDUCIARY INCOME TAX
INTEREST AND DIVIDEND INCOME SCHEDULE
Social Security Number or FEIN
Name
Part I
TAXABLE INTEREST INCOME
Part II
TAXABLE DIVIDEND INCOME
Interest on bank deposits, notes, mortgages from individuals,
Dividends and other distributions on stock are fully taxable.
corporation bonds, savings and loan deposits, and credit union
There is no dividend exclusion applicable to Arkansas.
deposits are taxable. Interest on obligations of other states
and subdivisions are fully taxable.
List below the names of the dividend sources and designate
ownership by writing Y (Yours), S (Spouse’s) or J (Joint).
List below the names of the interest sources and designate
ownership by writing Y (Yours), S (Spouse’s) or J (Joint).
YSJ
NAME OF PAYER
AMOUNT
YSJ
NAME OF PAYER
AMOUNT
00
00
00
00
00
00
00
00
00
00
00
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Add the amounts listed above and enter the total
Add the amounts listed above and enter the total
here and on Line 10, Form AR1000F/AR1000NR or
here and on Line 11, Form AR1000F/AR1000NR or
Line 1, Form AR1002F/AR1002NR.
Line 2, Form AR1002F/AR1002NR.
00
00
Part III
INCOME NOT SUBJECT TO ARKANSAS TAX
(See Instructions on pages 11 & 12)
00
00
Social Security
00
00
Railroad Retirement Benefits
00
00
Unemployment
00
00
Ministers Housing Allowance
00
00
00
00
00
00
TOTAL INCOME NOT SUBJECT TO ARKANSAS TAX: (Enter here and on Form AR1000F/AR1000NR, Line 51) .............
00
Page AR4 (R 4/22/15)
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