AR1103
STATE OF ARKANSAS
Election By Small Business Corporation
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Federal Employer Identifi cation Number (FEIN)
Election is to be Effective for AR Tax Year
NAICS Code
Beginning (MM/DD/YYYY)
Name of Corporation (Please print or type)
Date of Incorporation
Date Began Business in AR
Address
Date of Federal S Election
State of Incorporation
City
State
Zip Code
Corporation’s Telephone Number
(
)
Name and Title of Offi cer or Legal Representative who the State may call for Additional Information
Telephone number of Offi cer or Legal Representative
(
)
Fax
(
)
Email
A corporation may elect Subchapter S treatment for Arkansas income tax purposes only if it has elected Subchapter S treatment for federal
income tax purposes for the same tax year. The Arkansas election, with each shareholder’s consent, shall be fi led with the Director of the
Department of Finance and Administration on forms prescribed by the Director.
Name, Address, City, State and Zip
Shareholder’s signature. For this election to
Shareholder Information
Social Security Number
Code of each Shareholder
be valid, all shareholders must signify their
of Shareholder or FEIN
(Please Print or Type) (Required)
consent by signing below (Required)
(if applicable) See instructions
Do Not write in shaded areas
Signature
Date
NOTE: For this election to be valid, the consent of each stockholder must be shown on this form. If additional space is needed attach an AR1103
supplemental consent form or an additional schedule. Attach a copy of the IRS “NOTICE OF ACCEPTANCE AS AN S-CORPORATION” to Form AR1103.
Under penalties of perjury, I declare this Election is duly authorized and that the statements made to the best of my knowledge and belief are true, correct and
complete statements.
Offi cer’s Signature
Offi cer’s Title
Date
See Instructions-Important Notes
Mail Completed Form to: Corporation Income Tax Section, P.O.Box 919, Little Rock, AR 72203-0919
AR1103 (R 6/2015)
Incomplete Elections will be denied and will delay approval