Form Ar4ec(Tx) - Texarkana Employee'S Withholding Exemption Certificate

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FORM AR4EC(TX)
State of Arkansas
Texarkana Employee's Withholding Exemption Certificate
Employee Full Name
SSN
Employee Address
City
State
Zip
If Texarkana Exmption is Claimed for Arkansas Income Tax Withholding, Check One of the Following:
Texarkana, ARKANSAS (resident within city limits only)
Texarkana, TEXAS (resident within city limits only)
The above information is correct as of this date:
Under penalty of perjury, I certify that the above information is true and if there is a change in my status, I will
notify my employer within seven (7) days after the change occurs.
Signature
Date
INSTRUCTIONS FOR THE TEXARKANA EXEMPTION CERTIFICATE
Any employee who qualifies for the exemption should check the appropriate box then sign and date the form.
The place of physical residency should be placed in the employee address field. A post office box or route
number is not acceptable.
It is the responsibility of the employee to notify the employer within seven (7) days after any change to the
exemption claimed.
The completed certificate should be maintained by the employer.
The employer does not have the authority to cease withholding Arkansas Income Tax unless the employee
qualifies for, and checks, one the exemptions above.
Employees exempt from Arkansas Withholding, who would be required to file a return without the exemption,
must still file an Arkansas Individual Income Tax return.
If you have any questions regarding the Texarkana exemption please contact the Withholding Tax Department
at 501-682-7290.
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