AR1099PT
STATE OF ARKANSAS
INFORMATION RETURN
Report of Income Tax Withheld or Paid
on Behalf of Nonresident Member
Tax Year End of Pass-Through Entity __________________________
mm/dd/yyyy
Part A: Pass - Through Entity Information
Part B: Nonresident Member Information
Name of Entity:
Name:
Type of Ownership:
Type of Taxpayer:
Partnership
S Corporation
LLC
Trust
Other (Specify)
Individual
Corporation
LLC
Trust
Other (Specify)
Federal Identification Number:
Social Security Number or Federal Identification Number of Member:
Street Address:
Street Address:
City, State, ZIP:
City, State, ZIP:
Part C: Distribution and Tax Withholding or Payment Information for Nonresident Member
Total Amounts Distributed from Arkansas Sources: Arkansas Income Tax Withheld:
Arkansas Income Tax Paid on AR1000CR:
AR1099PT
STATE OF ARKANSAS
INFORMATION RETURN
Report of Income Tax Withheld or Paid
on Behalf of Nonresident Member
Tax Year End of Pass-Through Entity __________________________
mm/dd/yyyy
Part A: Pass - Through Entity Information
Part B: Nonresident Member Information
Name of Entity:
Name:
Type of Ownership:
Type of Taxpayer:
Partnership
S Corporation
LLC
Trust
Other (Specify)
Individual
Corporation
LLC
Trust
Other (Specify)
Federal Identification Number:
Social Security Number or Federal Identification Number of Member:
Street Address:
Street Address:
City, State, ZIP:
City, State, ZIP:
Part C: Distribution and Tax Withholding or Payment Information for Nonresident Member
Arkansas Income Tax Paid on AR1000CR:
Total Amounts Distributed from Arkansas Sources: Arkansas Income Tax Withheld:
AR1099PT (R 10/23/07)
CLICK HERE TO CLEAR FORM