Form Ar1000nr - Arkansas Individual Income Tax Return Nonresident And Part Year Resident - 2003

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N
2003 AR1000NR
ARKANSAS INDIVIDUAL INCOME TAX RETURN
Nonresident and Part Year Resident
Dept. Use Only
Jan 1 - Dec 31, 2003 or fiscal year ending ________ , 20 __
FIRST NAME(S) AND INITIAL(S) (List both if applicable)
LAST NAME(S) (See Instructions)
YOUR SOCIAL SECURITY NUMBER
PRESENT ADDRESS - NUMBER AND STREET, APARTMENT OR RURAL ROUTE
SPOUSE SOCIAL SECURITY NUMBER
CITY, TOWN OR POST OFFICE, STATE AND ZIP CODE
HOME TELEPHONE:
WORK TELEPHONE:
NONRESIDENT: (List State of residence)
PART YEAR RESIDENT: (Time of residency in AR)
ATTACH A COPY OF YOUR COMPLETE FEDERAL RETURN
1.
SINGLE (Or widowed before 2003 or divorced at end of 2003)
4.
MARRIED FILING SEPARATELY ON THE SAME RETURN
2.
MARRIED FILING JOINT (Even if only one had income)
5.
MARRIED FILING SEPARATELY ON DIFFERENT RETURNS
3.
HEAD OF HOUSEHOLD (See Instructions)
Enter spouse’s name here and SSN above _________________
If the qualifying person is your child but not your dependent,
6.
QUALIFYING WIDOW(ER) with dependent child.
enter this child’s name here: _____________________________
Year spouse died:(See Instructions) _______________________
HAVE YOU FILED A FEDERAL EXTENSION?
Check this box if you have filed an Automatic Federal Extension Form 4868. (See Instructions)
7A.
YOURSELF
65 or OVER
65 SPECIAL
BLIND
DEAF
HEAD OF HOUSEHOLD/
QUALIFYING WIDOW(ER)
SPOUSE
65 or OVER
65 SPECIAL
BLIND
DEAF
X $20 =
00
7B. First name(s) of dependents:
Multiply number of boxes checked from Line 7A ...
(Do not list yourself or spouse)
X $20 =
____________________________________________
Multiply number of dependents from Line 7B ........
00
7C. First name of developmentally disabled individual(s):
Multiply number of developmentally disabled
(See Instr.)
00
____________________________________________
X $500=
individuals from Line 7C .......................................
7D.TOTAL PERSONAL CREDITS: (Add Lines 7A, 7B and 7C. Enter total here and on Line 44) ..................................................... 7D
00
(A)
Your/Total
(B) Spouse Income
(C)
Arkansas
ROUND ALL INCOME FIGURES TO WHOLE DOLLARS
Income
Status 4 Only
Income Only
8.
Wages, salaries, tips, etc.: ........................................................................................... 8
00
00
00
Less
(Your/joint gross amt.) .......
00
00
00
9A. U. S. military compensation pay:
9A
$6,000
Less
(Spouse gross amt.) ..........
00
00
00
9B. U. S. military compensation pay:
9B
$6,000
10.
Minister’s income: Gross $ _____________ Less rental value $ ______________ 10
00
00
00
00
00
00
11.
Interest income: (If over $1,500, attach page AR4) ...................................................... 11
12.
Dividend income: (If over $1,500, attach page AR4) .................................................... 12
00
00
00
00
00
00
13.
Alimony and separate maintenance received: ............................................................ 13
00
00
00
14.
Business or professional income:
(Attach Federal Schedule C or C-EZ)
....................... 14
15.
Capital gains/losses from stocks, bonds, etc.:
(See Instr. Attach Federal Schedule D)
... 15
00
00
00
00
00
00
16.
Other gains or (losses):
(Attach Federal Form 4797)
................................................... 16
00
00
00
17.
Non-Qualified IRA distributions and taxable annuities: ................................................. 17
(See New Line 18 Instr, Page 15)
18A. Your/Joint Employer pension plan/Qualified IRA:
Less
00
00
00
00
Gross Distribution
Taxable Amount
18A
$6,000
18B. Spouse Employer pension plan/Qualified IRA:
(Filing Status 4 only)
Less
00
00
00
00
Gross Distribution
Taxable Amount
18B
$6,000
00
00
00
19.
Rents, royalties, partnerships, estates, trusts, etc.:
(Attach Federal Schedule E)
........... 19
20.
Farm Income:
(Attach Federal Schedule F)
................................................................ 20
00
00
00
00
00
00
21.
Other income: (List type and amount. See Instructions) ............................................... 21
00
00
00
22.
TOTAL INCOME: (Add Lines 8 through 21) ................................................................ 22
23.
Payments to
IRA and
MSA: (See Instructions) ........................................ 23
00
00
00
00
00
00
24.
Deduction for interest paid on student loans:(See Instructions) .................................... 24
25.
Contributions to Intergenerational Trust: (See Instructions) .......................................... 25
00
00
00
26.
Moving expenses:
(Attach Federal Form 3903 or 3903F)
............................................ 26
00
00
00
00
00
00
27.
Self-employed health insurance deduction: (See Instructions) ..................................... 27
28.
KEOGH and Self-employed SEP and Simple Plans: .................................................. 28
00
00
00
00
00
00
29.
Forfeited interest penalty for premature withdrawal: .................................................... 29
00
00
00
30.
Alimony/sep. maint. paid to: Name: ____________________ SSN: ____________ 30
31.
Border city exemption:
(Attach Form AR - TX)
............................................................ 31
00
00
00
00
00
00
32.
Support for permanently disabled individual:
(Attach Form AR1000DC)
....................... 32
33.
TOTAL ADJUSTMENTS: (Add Lines 23 through 32) .................................................. 33
00
00
00
34.
ADJUSTED GROSS INCOME: (Subtract Line 33 from Line 22) .................................. 34
00
00
00
Page NR1 (R 11/03)
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