Arkansas Amended Income Tax Return for Non-Residents

ARKANSAS INDIVIDUAL INCOME TAX AMENDED RETURN
NONRESIDENT AND PART YEAR RESIDENT

TAX YEAR: or fiscal year ending

CHECK ONLY ONE BOX:

1. SINGLE (Or widowed/divorced at end of tax year being amended)

2. MARRIED FILING JOINT (Even if only one had income)

3. HEAD OF HOUSEHOLD (See Instructions)

If the qualifying person is your child but not your dependent, enter this child’s name here:

4. MARRIED FILING SEPARATELY ON THE SAME RETURN

5. MARRIED FILING SEPARATELY ON DIFFERENT RETURNS

Enter spouse’s name here and SSN above:

6. QUALIFYING WIDOW(ER) with dependent child.

Year spouse died: (See Instructions)

PART 1: ORIGINAL

PART 2: AMENDED

First Name(s) and Initial(s)

Last Name

Present Address

City, State, and Zip Code

Telephone Numbers Home: Work:

Your Social Security Number

Spouse’s Social Security Number

Preparer’s Identification Number

Nonresident - List state of residence

Part-Year Resident - Dates you were a resident of Arkansas From: To:

7A. YOURSELF / SPOUSE

65 or over SPECIAL BLIND DEAF

65 or over SPECIAL BLIND DEAF

7B. First name(s) of dependents: Multiply number of dependents from Line 7B: x $

7C. First name of developmentally disabled individual(s): Multiply number of developmentally disabled individuals from Line 7C: x $500 =

7D. TOTAL PERSONAL CREDITS:

INCOME

8. Total Income:

9. Adjustments to Income:

10. Adjusted Gross Income:

11. Itemized/Standard Deductions:

12. Net Taxable Income:

TAX COMPUTATION

13. Select tax table:

LOW INCOME REGULAR

14. Combined Tax:

15. Enter tax from ten (10) year averaging schedule:

16. IRA and qualified plan withdrawal and overpayment penalties:

17. Total Tax:

TAX CREDITS

18. Personal Tax Credit(s):

19. State Political Contributions Credit:

20. Other State Tax Credit(s):

21. Child Care Credit(s):

22. Credit for Adoption Expenses:

23. Phenylketonuria Disorder Credit:

24. Business and Incentive Tax Credits:

25. TOTAL CREDITS:

26. NET TAX:

27. NET TAX:

27A. Enter the amount from Line 10, Part 2, Column C:

27B. Enter the total amount from Line 10, Part 2, Columns A and B:

27C. Divide Line 27A by 27B. Enter the decimal amount:

27D. APPORTIONED TAX LIABILITY:

PAYMENTS

28. Arkansas Income Tax withheld:

29. Estimated tax paid or credit brought forward from preceding tax year:

30. Early childhood program: Certification No. Attach federal Form 2441 and Certification Form AR1000EC

31. Amount Paid with Return:

32. Amount Paid after Return was filed:

33. TOTAL PAID:

34. Enter prior Overpayment/Refund/Estimate carried forward:

35. TOTAL PAYMENTS:

REFUND OR TAX DUE

36. AMOUNT TO BE REFUNDED TO YOU:

37. AMOUNT DUE:

PLEASE SIGN HERE

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct and complete.

May the Arkansas Revenue Agency discuss this return with the preparer shown to the left? Yes No

EXPLANATION OF CHANGES TO INCOME, DEDUCTIONS, AND CREDITS (REQUIRED)

Attach supporting forms and schedules for items changed and give explanations for each change. If you do not attach the required information, processing of your Form AR1000ANR may be delayed. Include your name and Social Security Number on any attachments.

Has your tax return been adjusted by the IRS? If yes, attach notices. Yes No

Mail to: Amended Tax Group
P. O. Box 3628
Little Rock, AR 72203

Complete and attach Form AR1000V to your check or money order payable in U.S. Dollars to “Dept. of Finance and Administration” for the tax due. Include your SSN on the check or money order. To pay by credit card, see Instructions.